Clostridioides difficile infection (CDI) remains a pressing challenge in older adults, particularly those with comorbidities, leading to significant mortality and healthcare costs. Now, new research suggests that combining hospital-at-home care with fecal microbiota transplantation (FMT) offers a cost-effective solution, reducing hospital stays and saving healthcare dollars in this vulnerable population.
In a randomized clinical trial of 217 patients aged 70 years and older, researchers evaluated the economic impact of this dual intervention against standard treatment over a 90-day period. The study employed a cost-utility analysis from a healthcare sector perspective, measuring outcomes in quality-adjusted life years (QALYs) with a willingness-to-pay threshold of 24,863 USD per QALY.
The findings were compelling: the hospital-at-home and FMT approach was dominant, meaning it both improved health outcomes and reduced costs. Specifically, the intervention yielded an average savings of 2,764 USD per patient while delivering a small but meaningful QALY gain (0.004). A critical driver of these savings was the reduction of six hospital admission days per patient on average, despite higher resource use in other areas.
Sensitivity analyses confirmed the robustness of the results across varying cost assumptions and perspectives, including hospital-only views and adjustments for missing data. Notably, the intervention significantly increased the odds of clinical resolution, providing added reassurance for clinicians considering alternative care models for CDI management.
For healthcare providers treating older adults with CDI, this research offers actionable insights: integrating hospital-at-home services with FMT not only supports patient outcomes but also aligns with cost-containment goals in the healthcare system.
Reference: Olesen RH et al. Cost-Effectiveness of Hospital-at-Home and Fecal Microbiota Transplantation in Treating Older Patients With Clostridioides difficile. Clin Infect Dis. 2025;ciaf104.
