Faeces transplantation: effective treatment with economic benefits

Healthy donor faeces is a life-saving therapy. In addition, the treatment provides huge cost savings. When used in the right intestines, faeces transplantations saves about eight million Danish kroner each time fifty patients are treated for the deadly diarrhoea infection Clostridium difficile at a public hospital.

These are the perspectives in the first observational study in the world to detail how things went for the fifty patients who received a faeces transplantation for Clostridium difficile colitis in 2014 and 2015 as an alternative to the antibiotics that are otherwise regarded state-of-the-art.

"Our study shows that on average the patients each avoided seventeen days in hospital the first year after their faeces transplantation. They went from being hospitalised 37 days a year to 20 days a year in average, following the faeces transplantation,” says Christian Lodberg Hvas. He is a consultant at the Department of Hepatology and Gastroenterology at Aarhus University Hospital and a Clinical Associate Professor at the Department of Clinical Medicine at Aarhus University, as well as last author on the study which has just been published in the scientific journal Therapeutic Advances in Gastroenterology.

A conservative estimate

The study concludes that the total hospital costs per patient were 42% lower and that the average cost decreased from DKK 420,000 to DKK 243,000 per year. The average amount covers large individual differences that influence the bottom line because some of the patients were so ill that they ended up being moved in and out of intensive care, where a bed costs up to DKK 35,000 a day. The cost of an ordinary hospital bed is approx. 8,000 DKK per day depending on how it is calculated.

“The DKK 175,000 that we save with each patient each year is calculated based on the costs of hospitalisation, antibiotics and the faeces transplantation. Although a huge annual saving, it is a conservative estimate. We only included hospital costs, and because half of the patients were below 60 years of age, factors such as loss of earnings should be counted in,” says Christian Lodberg Hvas.

It is the first time that a scientific study has been published based on real world data describes the costs of faeces transplantation compared to the alternative – which is treatment with antibiotics using products such as vancomycin and fidaxomicin.

“There are other studies that make theoretical calculations about what the different types of treatment cost society, but this is the first time anyone has made calculations based on the patients’ actual medical history – with costs and derived hospital savings calculated one year before and one year after the faeces transplantation,” he says.

Calculated in minute detail

In the actual study, the Department of Hepatology and Gastroenterology has provided data in the form of patient medical records for all of the fifty patients who received a faeces transplantation at Aarhus University Hospital during 2014 and 2015.

All of the medical records and documents have then been reviewed in minute detail with a calculator at hand at the Department of Business and Management at Aalborg University with health economist and Professor Lars Holger Ehlers overseeing things. Following this, the results have been put through what is known as a sensitivity analysis to prevent any over-interpretation of the results.

“As an example, we take into account that these patients have already contracted Clostridium difficile in connection with another illness – and this is what characterises the bacteria – and that they spend many days in hospital for this reason alone. So we can be certain that the large difference in hospital costs is due to the Clostridium difficile disease itself and the subsequent faeces transplantation and not other diseases. This is where we use the sensitivity analysis and test different scenarios,” professor Lars Holger Ehlers explains.

Towards a new standard treatment

Lars Holger Ehlers collaborates with Christian Lodberg Hvas in CEFTA, the Centre for Faecal Microbiota Transplantation at Aarhus University Hospital, which also includes Professor Tine Rask Licht from the Technical University of Denmark and Consultant and Professor and Chair Christian Erikstrup from the Blood Bank and Immunology at Aarhus University Hospital.

CEFTA works with the support of the Innovation Fund Denmark to turn faeces from healthy, registered and thoroughly tested donors into a standard treatment for the persistent bacteria which is today regarded as one of the most dangerous bacteria to humans. To do this, a faeces bank is being created in Aarhus organised according to the principles of the blood bank.

"The faeces transplantation is a new and extremely effective treatment. The introduction of new treatments is usually very expensive, but here we have a form of treatment that on top of everything also saves society millions of Kroner every month. If we can establish a system that safeguards both patients and donors, then it’ll be of huge benefit for everyone. And we’re well on the way to doing that,” says Christian Lodberg Hvas.

The research results – more information

• The study is an observational study that included all patients who were given a faeces transplantation for recurrent Clostridium difficile infections during 2014 and 2015 at the Department of Hepatology and Gastroenterology, Aarhus University Hospital.
• The study was carried out in collaboration with the Department of Business and Management at Aalborg University led by Professor Lars Ehlers.
• In the study, all hospital costs in both the year before and the year after the faeces transplantation were calculated according to health economic research methods, in particular the time-driven activity-based costing approach.
• The study was financed by the Danish Regions Medical Fund and received support from Innovation Fund Denmark that invested DKK 17 million in the continued development and quality assurance of faeces transplantation, including the organisation of the faeces bank in Aarhus.
• Direct link to the scientific article on which the media coverage is based: https://journals.sagepub.com/doi/full/10.1177/1756284819843002
  

Contact

Consultant, PhD, Clinical Associate Professor, Christian Lodberg Hvas
Department of Hepatology and Gastroenterology, Aarhus University Hospital
Department of Clinical Medicine, Aarhus University
Tel.:(+45) 2835 1839
Email: christian.hvas@auh.rm.dk

Professor Lars Holger Ehlers
Danish Center for Healthcare Improvements
Department of Business and Management
Mobil: (+45) 6018 0848
Mail: lehlers@business.aau.dk