Successful Post-Discharge Completion of Fidaxomicin Therapy Without Financial Toxicity
February 1, 2022 3 minutes read
By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
SYNOPSIS: Post-discharge completion of fidaxomicin therapy was achieved for most patients with multidisciplinary proactive intervention.
SOURCE: Fang N, Ha D, Dong K, et al. Successful fidaxomicin hospital discharges of adult patients with Clostridioides difficile infections post 2021 guidelines — are economic barriers finally coming down? Clin Infect Dis 2021; Dec 31:ciab1061. doi: 10.1093/cid/ciab1061. [Online ahead of print].
In 2021, the Infectious Diseases Society of America (IDSA) acknowledged the accumulated evidence indicating the superiority of fidaxomicin over vancomycin in the treatment of Clostridioides difficile infection (CDI) as a result of the lower associated incidence of disease recurrence.1 Resistance to the acceptance of this recommendation has occurred because of the greater drug acquisition cost of fidaxomicin. Besides the inpatient costs, there is concern that, having initiated therapy in that setting, the costs to the patient after discharge would be prohibitive because of a lack of adequate coverage by third party payers.
After Stanford adopted the IDSA recommendation, Fang and colleagues, in a small study, examined the frequency of successful discharge for completion of fidaxomicin therapy as outpatients. A successful discharge, defined as receipt of the drug within one day of discharge, was achieved in 12 of the 15 evaluable patients.
Insurance coverage (Medicare, Medicaid, commercial, or Tricare) was available for all 15 prescriptions, with copays of only $0 to $4 in 11. One had a copay of $35, two had a copay of $50, and one had a copay of $1,800. Of the three unsuccessful cases, one resulted from a delay in acquisition of fidaxomicin by the local pharmacy, one was because of delayed third party authorization, and one was because of an $1,800 Medicare copayment — the latter two continued their treatment with vancomycin. One patient (7%) experienced CDI recurrence within 30 days.
COMMENTARY
This experience indicates that one perceived barrier to fidaxomicin use in the post-discharge treatment of CDI is less than many imagine. The authors make a series of recommendations to assure that patients are able to receive this drug upon leaving the hospital and to do so without experiencing significant financial toxicity. These recommendations include sending prescriptions to the dispensing pharmacy at least one to two days prior to discharge and requesting expedited review of prior authorization. Involvement of a transitions of care pharmacist can expedite these matters, and implementation of a “meds-to-beds” program may be the best of all from the point of view of the patient. The latter delivers medications directly to patients before they leave the hospital. All 15 patients in the study reported had some sort of insurance. For uninsured patients, a manufacturer patient assistance program for fidaxomicin is available.2
Thus, planning prior to discharge and multi-disciplinary provider action, involving clinicians and pharmacists, can readily overcome any continued perceived or real impediments to post-discharge completion of fidaxomicin therapy.
REFERENCES
- Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 2021; 73:e1029-e1044.
- Merck Programs to Help Those in Need — Product. https://www.merckhelps.com/DIFICID%20Tablets
Post-discharge completion of fidaxomicin therapy was achieved for most patients with multidisciplinary proactive intervention.
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