Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study

Abstract

BackgroundClostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain.MethodsWe conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005–2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation.ResultsThe average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7–13.6) and 9.7 (90 % CI: 9.6–9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9–$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay.ConclusionsThis review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1786-6) contains supplementary material, which is available to authorized users.

Retracted: Prevalence, antibiotic resistance, and toxigenic gene profile of the Clostridium difficile isolated from molluscan shellfish

“…It is mainly a causative agent of wide groups of complications, ranging from asymptomatic colonization to antibiotic associated diarrhea, pseudomembranous colitis, toxic megacolon, intestinal perforation, and even death (Johnson, ; Smits et al, ). Clostridium difficile infection (CDI) is an important cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of about 3 billion dollars (Zhang et al, ). Additionally, there were 3 million cases of C. difficile related hospitalizations, or approximately 1% of the total of more than 300 million hospitalizations in the United States annually (Freeman et al, ; Zhang et al, ).…”

Fidaxomicin versus Vancomycin as a First‐Line Treatment for Clostridium difficile–Associated Diarrhea in Specific Patient Populations: A Pharmacoeconomic Evaluation

“…Data describing the proportion of patients with recurrence who are readmitted are scarce, and this estimate may be conservative given the various high‐risk subpopulations considered in this model. Finally, a recent publication reported average direct hospital costs ($21,448) and hospital LOS (11 days) attributable to C. difficile infection management higher than that used in the current model; therefore, these findings might underestimate the cost‐effectiveness of fidaxomicin.…”

Estimating Local Costs Associated WithClostridium difficileInfection Using Machine Learning and Electronic Medical Records

“…In the analysis unadjusted for time-to-infection, differences in LOS were often greater than national averages from similar unadjusted studies, 3,5,6 but changes in the case definition resulted in substantial changes in the estimated differences in LOS. Although two hospitals reported good concordance between ICD-9 codes and CDI toxin assay results, 32,33 this is not necessarily the case for all hospitals.…”