If the pricing is similar or only slightly more than Vanco, then Fida will be use the first used treatment when a patient is suspected of having CD. From a long term revenue standpoint that is a best case scenario.
Vancocin capsules cost $33 per pill. A course is qid (4 times a day) for 10 to 14 days.
The weekly cost is around $900.
Vancomycin from the IV solution can be made into a vancomycin slurry that is taken orally. In this form, the cost is around $48 per week.
Metronidazole (flagyl) is also used for CDI but it is not approved by the FDA. This is the least expensive option, costing only $15 per week or less. But studies show it is not as effective as vanco, especially if one is relapsing. Also, Flagyl should not be used by people who are relapsing as taking too much of this drug can cause neuropathy.
"Optimer also showed a number of data rich slides that showed it had done its market research homework. Optimer showed studies that suggest that each case of CDI recurrence results in $10,000-$34,000 in additional cost to healthcare and that treatment with fidaxomicin would lower that burden by $2,000-$6,000 per patient. Polls also showed that 32% of doctors would make fidaxomicin their first-line therapy for CDI, while 52% would make it their second-line choice."
"Although therapy of C. difficile infection is fraught with challenges, fidaxomicin appears to be an important advance, notes Herbert L. DuPont, MD, with the University of Texas School of Public Health, St. Luke's Episcopal Hospital, Baylor College of Medicine, and Kelsey Research Foundation, all in Houston, Texas, in a related editorial.
"If studies with fidaxomicin confirm a favorable clinical response and a significant decrease in the rate of recurrence after treatment, this new agent could become a recommended therapy for C. difficile infection," Dr. DuPont adds.
Independent Comment: First Drug to Beat Vancomycin
John G. Bartlett, MD, professor of medicine at Johns Hopkins University School of Medicine, in Baltimore, Maryland, notes that fidaxomicin is the first drug to ever "beat oral vancomycin in a clinical trial for CDI [C difficile infection]."
According to Dr. Bartlett, the benefit with vancomycin was the result of decreased relapses, because it has a less pronounced impact on the colon microbiome, and "about 20-25% of patients have relapses so that is the population that will benefit," he told Medscape Medical News.
"Currently, oral vancomycin is the only drug that is FDA approved for CDI," Dr. Bartlett said. "Metronidazole is the other commonly used drug, but it is not as good as vancomycin and was never FDA approved for this indication."