Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Abstract

BACKGROUND: Clostridioides difficile infection (CDI) affected an estimated 365,000 persons in the United States in 2017. Despite a nationally decreasing trend of CDI cases, the population incidence of recurrent CDI (rCDI) has not improved. Elderly individuals (aged ≥ 65 years) are at higher risk of CDI, rCDI, and complicated CDI compared with younger individuals. OBJECTIVE:To analyze Medicare fee-forservice data for 12 months after an initial CDI episode, in order to obtain real-world data on health care resource utilization (HRU) and costs for elderly patients with CDI and rCDI. METHODS:A retrospective cohort study of patients who were aged ≥ 65 years and had a first (index) CDI diagnosis from January 1, 2010, to December 31, 2016, and continuous enrollment in Medicare Parts A, B, and D during the 12-month pre-index and 12-month post-index periods was conducted. A CDI episode was identified by either an inpatient stay with CDI diagnosis code or an outpatient medical claim with a CDI diagnosis code plus a CDI treatment. Each CDI episode was followed by a 14-day CDI claim-free period after the last CDI claim or end of CDI treatment. rCDI was a second or subsequent episode of CDI that occurred within an 8-week window after the 14-day CDI claim-free period. The number of CDI and rCDI episodes, HRU, time to recurrence, and total all-cause direct medical costs were calculated over the 12-month pre-index (baseline) and 12-month follow-up periods and stratified by number of rCDI episodes (No rCDI, 1 rCDI, 2 rCDI, 3+ rCDI). RESULTS:A total of 268,762 patients with an index CDI were included. Mean age was 78.3 years, and 69.0% were female. HRU was higher during the 6 months immediately pre-index versus 7-12 months pre-index, including a higher proportion of patients with a hospital admission (55.1% vs. 27.5%) or emergency department visit (41.3% vs. 27.4%), respectively. Moreover, 34.7% of the study population experienced rCDI. Of those What is already known about this subjectaffects more than 350,000 individuals in the United States annually and confers substantial physical, social, and emotional burden to the patient.• The burden of recurrent CDI (rCDI) has not improved, despite a nationally decreasing trend of all CDI cases in recent years.• Elderly individuals are at higher risk than younger individuals for CDI, rCDI, and complicated CDI.

Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective

“…There are (1) well-documented concerns with HCA-CDIs [8,10,11], (2) clinical and economic consequences associated with HCA-CDIs [9][10][11][29][30][31][35][36][37][38], and (3) a need for better proactive primary HCA-CDI prevention strategies [14,15,20]. As such, the intent of this study was to assess the economic impact of prioritizing the use of omadacycline (an agent approved for the treatment of adult patients CABP that has a documented lower propensity to cause CDI [21][22][23][24]), over other guideline-concordant inpatient therapies (fluoroquinolones and ceftriaxone) [19], in hospitalized CABP patients at high risk for CDI [3].…”

“…The model was limited to the attributable HCA-CDI hospital costs associated with the first CDI episode. Data suggest that the attributable healthcare may extend the first HCA-CDI hospitalization [7,[9][10][11]35,36,38,[41][42][43][44]. As such, results of the study should be viewed as conservative estimates of the potential cost savings associated with omadacycline relative to use of guideline-concordant inpatient CABP treatments in high-risk CDI patients with CABP.…”

“…Reports have shown that 18-25% of patients will experience at least one CDI recurrence [12,15,17,35,41,42,44]. In patients with ≥1 recurrence, the risk for subsequent recurrences increases to 45-65% [11,38,45]. A meta-analysis showed that that continuation of non-C. difficile antibiotics, advanced age, and use of antacid medications places patients at an increased risk for recurrence [46] and these risk factors are commonplace in CABP patients [19,21].…”

“…The occurrence of CDI places a substantial economic burden on the US healthcare system, resulting estimated annual attributable healthcare costs of nearly USD 5 billion in the USA [9]. It is also a significant source of lost revenue for many US hospitals as the additional healthcare expenditures associated with HCA-CDI often result in total hospital costs that exceed the amount reimbursed [10,11]. Due to the clinical and economic consequences associated with CDI, prevention of CDI is now a mandated national priority in the USA [12] and is part of the Centers for Medicare & Medicaid Services' Hospital-Acquired Condition Reduction Program (HACRP) [13].…”

Heterogeneity of Randomized Controlled Trials of Fecal Microbiota Transplantation in Recurrent Clostridioides difficile Infection

“…Clostridioides difficile infection (CDI) is the most common healthcare-associated infection in the USA and is frequently complicated by recurrence, with up to 35% of patients developing recurrent CDI (rCDI) following an initial episode and over 50% developing recurrences after two or more episodes [1][2][3][4]. Current guidelines from the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend FMT after "appropriate antibiotic treatments for at least two recurrences" of CDI [5].…”