Coste de la diarrea asociada a Clostridium difficile en España

Abstract

RESUMENFundamentos: No se dispone de estudios adecuados del coste de las diarreas asociadas a Clostridium difficile (DACD) en España. El objetivo del estudio es estimar el coste de las DACD para el Sistema Nacional de Salud (SNS). Métodos:Se realizó un modelo económico para calcular el coste por episodio de DACD (por antibióticos, prolongación del ingreso hospitalario, procedimientos quirúrgicos, medidas de control de la infección, recurrencias de las infecciones tratadas) y el coste anual de la DACD. El uso de recursos en la práctica clínica se obtuvo mediante un panel Delphi de clínicos españoles con experiencia en la DACD y los costes unitarios (€ 2012) de fuentes españolas.Resultados: Se estimó que anualmente se produjeron 7.601 episodios de DACD en España (incidencia de 17,1 episodios/año/10.000 altas hospitalarias) con un gasto anual para el SNS de 32.157.093 €. Coste por episodio de DACD: 3.901 € (infección inicial), 4.875 € (primera recurrencia) y 5.916 € (segunda recurrencia). Coste total de las recurrencias: 10.426.750 € anuales. El 95,6% del gasto se debería a la prolongación de la duración de la estancia hospitalaria, el 0,5% a tratamientos antibióticos, el 2,8% a intervenciones quirúrgicas y el 1,1% a las medidas de control de la infección. Los resultados del estudio fueron sensibles a la incidencia y tasa de letalidad de la DACD en España y a la duración de la prolongación de la duración de la estancia hospitalaria debida a la DACD.Conclusiones: Según este estudio, el gasto asociado a la DACD se debe fundamentalmente a la prolongación de los ingresos hospitalarios y tiene un gran impacto económico en el SNS.Palabras clave: Clostridium difficile. Diarrea. Vancomicina. Metronidazol. Coste de la enfermedad.

Economic assessment of fidaxomicin for the treatment of Clostridium difficile infection (CDI) in special populations (patients with cancer, concomitant antibiotic treatment or renal impairment) in Spain

“…According to the authors of this study, the maximum extended stay value used in the model is clinically plausible according to their experience. This assumption was conservative, since the alternative would have been to take the value of 27.3 days from the previous Spanish study [12] or the maximum value observed in England (32.42 days) [23]. However, as this is the most critical variable of the analysis (we must clarify that it is the same for both treatments), it was explored further in the deterministic and probabilistic sensitivity analyses.…”

“…In the absence of Spanish data on the maximum value of the extended stay attributable to CDI, it was necessary to make an estimate based on the experience of the Spanish panel of clinical experts. According to a study on CDI cost in Spain [12], the extended stay due to CDI can be up to 27.3 days when recurrences or outbreaks occur. In this regard, the expert panel decided to take a value of 26 days.…”

“…However, these have been minimised by using economic analysis performed by means of a model recently published [17][18][19][20][21] with probabilistic Monte Carlo analyses [39], which made it possible to test the robustness of the results, in comparison with the deterministic models. All the costs used in the model were taken from Spanish sources [12,26]. The cost-effectiveness analysis results of the model were very stable in the three subgroups according to the results of the probabilistic analysis.…”

“…The drugs acquisition cost was calculated from approved prices [26]. The cost of hospitalisations, admission to the ICU, severe CDI complications and visits to primary care general practitioners or home visits were obtained from the Spanish public healthcare prices [27][28][29] and from a Spanish study [12] ( Table 2). The time horizon (the duration of the model) was 1 year, during which all the possible recurrences of a patient with CDI [18] were recorded.…”

“…In a Spanish study, the crude hospital mortality rate was higher in cases with CDI (31 %) than in controls that did not present this infection (6.6 %) [11]. According to a different study, it is estimated that there are approximately 7,600 episodes of CDI per year in Spain, with a financial burden of €32,157,093 on the National Health System (NHS) [12]. The initial management of patients with CDI should include, if possible, the discontinuation of any antibiotic that might have affected the normal microbial ecology of the large intestine.…”