Health Technology Assessment on Fecal Microbiota Transplantation for Recurrent Clostridioides difficile infection

Condition Description - Clostridioides difficile infection (CDI) is a bacterial infection that affects the colon, leading to symptoms such as diarrhea, fever, and abdominal pain. Recurrent CDI is a significant healthcare challenge, particularly for patients who do not respond to standard antibiotic treatments. The incidence of CDI has been rising in Canada, with increased cases observed in healthcare settings due to antibiotic use and immunocompromised populations. Recurrent CDI presents a major burden, necessitating alternative treatment approaches for patients who fail conventional therapies.

Current treatment options - In British Columbia, the primary treatment for CDI includes antibiotic therapies such as vancomycin and fidaxomicin, with metronidazole used in some cases. However, for patients experiencing recurrent CDI, these standard treatments often become less effective, leading to multiple relapses. There are limited treatment options for recurrent cases beyond continued antibiotic courses, which contribute to the cycle of reinfection and antibiotic resistance.

Description of the Assessed Technology(ies) - Fecal Microbiota Transplantation (FMT) involves the transfer of stool from a healthy donor to the gastrointestinal tract of a patient suffering from recurrent CDI. The purpose of FMT is to restore the natural gut microbiome, which is often disrupted by antibiotic use. The intervention can be administered through various methods, including colonoscopy, enemas, and oral capsules. While FMT is of interest for many applications, there is ongoing research for the effective resolution of recurrent CDI, reducing reliance on repeated antibiotic use. FMT has the potential to decrease the overall burden of CDI on the healthcare system by lowering rates of recurrence and hospitalizations.

Health Technology Assessment Committee’s Findings:

After review of the HTA, the Health Technology Assessment Committee found that the available evidence suggests Fecal Microbiota Transplantation (FMT) is at least as clinically effective compared to antibiotic treatment for recurrent CDI. Key findings included:

• The method of administration may significantly impact treatment availability and associated costs.
• The development of a provincial stool bank should be weighed as an option in the case of adoption for ensuring patient safety and supply chain logistics.
• The inclusion of multiple delivery methods, such as lyophilized capsules, should be evaluated for feasibility and effectiveness.
• Appropriate patient education and resources regarding consent for the use of a human product as a treatment must be considered.

It will be at the discretion of each health authority to assess the value of potential benefits in comparison to the additional implementation cost of FMT options.