Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Patients with Irritable Bowel Syndrome

Studies have demonstrated clinical benefits of fecal microbiota transplantation (FMT) for treatment of irritable bowel syndrome (IBS). This study aimed to evaluate the cost-effectiveness of FMT versus standard drug treatment for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective.

Two 1-year Markov models were developed to examine the outcomes of FMT versus standard drug treatment in patients with constipation-predominant IBS (IBS-C) and diarrhea-predominant IBS (IBS-D). The primary model outcomes included direct medical cost and quality-adjusted life-years (QALYs) gained. Model inputs were obtained from literature and public data. Sensitivity analyses were performed to examine the robustness of model results.

In the base-case analysis, FMT gained higher QALYs (by 0.0159 QALYs for IBS-C and 0.0166 QALYs for IBS-D) with cost savings (USD 7,835 for IBS-C and USD 9,015 for IBS-D) when compared to standard drug treatment. Key influential parameters identified by one-way sensitivity analysis were response probabilities of FMT and first-line treatment, the utility values of therapeutic response and nonresponse, and FMT cost. The probabilities of FMT to be accepted as the preferred strategy at a willingness-to-pay threshold of USD 50,000/QALY were 99.86% and 99.89% for IBS-C and IBS-D, respectively.

FMT appears to be cost-effective for patients with moderate-to-severe IBS who failed to respond to first-line therapy from the US payer's perspective.