Faecal microbiota transplant for recurrent Clostridioides difficile infection

1.1 Faecal microbiota transplant (FMT) is recommended as an option to treat recurrent Clostridioides difficile infection in adults who have had 2 or more previous confirmed episodes.

1.2 FMT treatment is cheaper than almost all treatment options with antibiotics. It is not cost saving compared with vancomycin taper pulse if it's given using an enema. However, FMT via enema would only be an option for the minority of people who cannot have FMT by another route.

Why the committee made these recommendations

Clinical trial evidence shows that FMT treatment is significantly better than antibiotics alone at resolving a C. difficile infection in people who have had 2 or more previous infections.

Modelling shows that FMT treatment is cheaper than almost all treatment options with antibiotics. It is cost saving by £769 compared with vancomycin taper pulse (VTP) if it's given using colonoscopy, and by £8,297 compared with vancomycin if it's given using an oral capsule. This assumes FMT costs £1,300 for 50 ml, and that a quarter of people having antibiotics alone are treated in the community (that is, outside hospital). FMT is not cost saving compared with VTP if it's given using an enema – this costs £1,287 per person more.