Exploring the variation across countries in access to faecal microbiota transplantation (FMT)

To improve and standardise the delivery of FMT for recurrent C. difficile infections, health services could raise clinician awareness of and training in FMT services, maintain patient registries and develop metrics to monitor outcomes, develop better regulation and guidelines on the delivery of FMT, and tackle reimbursement challenges.

What is the issue?

In recent years, there has been a growing interest in the use of Faecal Microbiota Transplantation (FMT) to treat recurrent C. difficile infection. C. difficile is a bacteria that is commonly found in the human digestive system. In healthy people, the bacteria does not cause any harm, but the use of antibiotics can kill the gut bacteria that keeps C. difficile supressed, causing it to multiply to toxic levels.

FMT involves transferring a mixture of liquid stool from a donor into the intestines of the patient. Numerous ongoing studies suggest FMT to be safe and effective. However, there are a number of challenges associated with the implementation and administration of FMT. Thus, there is a need for further research in this field, to understand how to support good practice in the care of patients with recurrent C. difficile infection.

How did we help?

RAND Europe was commissioned by Ferring Pharmaceuticals to undertake an independent study that explored:

• Current practice and differences in the establishment, running and distribution of stool banks and in the availability of FMT to patients with recurrent C. difficile infection.
• Key themes related to standardisation and regulation of FMT practice.
• Potential challenges related to FMT and areas in need of improvement for patient care.

The main focus was on learning from a range of countries, including the UK, Italy, Australia and Canada. The project included:

• A rapid evidence assessment to synthesise the knowledge base on the availability of FMT for patients with recurring C. difficile infection.
• Key informant interviews with clinical and non-clinical experts (e.g. microbiologists) to further explore the themes arising from the rapid evidence assessment and identify gaps in the literature.
• Consultative workshops with an expert panel.

RAND Europe collaborated with a panel of clinical and non-clinical experts in the delivery of this work.

What did we find?

We identified a range of challenges in setting-up and delivering FMT services when caring for patients with recurrent C. difficile infections, including:

• Limited capacity within the healthcare system in terms of workforce skills and availability and the availability of stool banking facilities.
• Recruiting donors and getting donations that can pass stringent stool screening criteria.
• Patient access owing to the limited number of or geographical distance of treatment facilities.
• Cost, regulation, and reimbursement of the FMT procedure.

What can be done?

There are a number of opportunities and priorities for improving and standardising the delivery of FMT for recurrent C. difficile infections.

1. Raise awareness of FMT services and referral processes with clinicians, and integrate training about FMT into medical education curricula to improve awareness of this treatment option and patient access to FMT.
2. Maintain patient registries and develop metrics to monitor outcomes can support research into the long-term effectiveness of FMT.
3. Develop better in-country regulation and guidelines to standardise the delivery of FMT.
4. Tackle reimbursement challenges to support the set-up of more FMT centres and thus increase patient access to the procedure.

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