Consumption and Expenditure on Fidaxomicin and Oral Vancomycin for Clostridioides Difficile Infection: A 12-Year Longitudinal Study of 43 Countries and Regions.

BACKGROUND:Current treatment guidelines recommend fidaxomicin and oral vancomycin as first-line treatments for Clostridioides difficile infection (CDI). Disparities in the prevalence of CDI and the availability of novel treatments necessitate understanding the contemporary trends in their consumption at the global level. METHODS:This longitudinal study used global pharmaceutical sales from IQVIA-MIDAS for fidaxomicin and oral vancomycin in 43 countries from 2012 to 2023. We measured defined daily doses per 100,000 inhabitants per year (DDD/100K) and manufacture-level prices, calculating changes using compound annual growth rates (CAGR). We conducted interrupted time-series analyses to assess the impact of guideline updates by Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America (IDSA/SHEA) on quarterly consumption. RESULTS:Overall fidaxomicin consumption increased from 21.68 DDD/100K in 2012 to 126.86 DDD/100K in 2023 (CAGR = 17.42%) and similar increases in expenditure (0.07-0.34 USD/capita; CAGR = 14.96%). Oral vancomycin consumption increased from 71.61 to 120.82 DDD/100K (CAGR = 4.87%), although with a decreasing trend in expenditure (0.20-0.03 USD/capita; CAGR = -15.16%). The earliest adoption of fidaxomicin in middle-income economies occurred five years later than in high-income economies. Despite higher CAGRs, consumption of fidaxomicin and oral vancomycin in middle-income economies was only 1.9% and 2.3%, respectively, of that in high-income economies in 2023. Following the IDSA/SHEA guideline updates, fidaxomicin consumption in Northern America increased immediately. CONCLUSION:Consumption of fidaxomicin and oral vancomycin continues to increase globally; however, significant economic and geographical disparities in utilization highlight inequitable access to first-line CDI treatments.