The ongoing challenge of Clostridioides difficile infection in Austria: economic evaluation of two recommended treatment pathways

OBJECTIVES: resilient spores through the fecal-oral route. While most infections originate in hospitals or long-term care facilities, 20-30% are community-acquired. In Austria, national surveillance data report 769 severe CDI cases in 2024, indicating a substantial disease burden. This analysis compares two treatment scenarios: (1) the pathway recommended by the Austrian Society of Gastroenterology and Hepatology (ÖGGH), which designates fidaxomicin as first-line therapy and reflects its reimbursement under the national reimbursement-code (positive list) as of December 2025, and (2) clinical practice prior to reimbursement, when the use of fidaxomicin was restricted by reimbursement constraints (reference pathway). METHODS: A decision-tree model simulated CDI treatment. Patients could receive up to three successive therapies per episode and experience up to two recurrences. Treatment duration was fixed for 10 days. Inputs-patient characteristics, response rates, recurrence risk, utilities, CDI-related mortality, and costs (2025€)-were sourced from literature and validated by clinical experts. The model was evaluated over a lifetime horizon from the perspective of the Austrian healthcare system. Deterministic and probabilistic sensitivity-analyses tested robustness. RESULTS: Average lifetime costs per patient were 4,026.86€for the ÖGGH pathway and 4,082.90€for the reference pathway, yielding incremental savings of -56.04€. Higher treatment costs (+234.29€) were offset by reduced downstream costs (-290.33€). The ÖGGH strategy improved outcomes, with 0.12 additional QALYs (7.01 vs. 6.89) and 0.20 life years gained (10.75 vs. 10.55), resulting in a dominant incremental cost-utility ratio (-478.25€/QALY). CONCLUSIONS: Fidaxomicin reimbursement is the dominant strategy and supports implementation of the ÖGGH guideline in Austria.