Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey

Abstract

BackgroundEvidence of humanistic detriments of Clostridium difficile infection (CDI) remains limited.AimsTo assess humanistic burden associated with CDI.MethodsSelf-reported National Health and Wellness Survey data between 2013 and 2016 were analyzed for the USA, five European countries, China, and Brazil. Outcome measures included SF-36v2® for health-related quality of life (HRQoL) and Work Productivity and Activity Impairment questionnaire. Respondents (≥ 18 years old) were classified as (1) currently treated doctor-diagnosed CDI (C-CDI), (2) doctor-diagnosed prior CDI (P-CDI), or (3) never experienced CDI (NO-CDI). Regression modeling assessed the association between CDI status and outcomes, adjusting for potential confounders.ResultsOf 352,780 respondents, 299, 2111, and 350,370 met the criteria for C-CDI, P-CDI, and NO-CDI, respectively, with 45% of the total from the USA. C-CDI and P-CDI respondents were older, were less often employed and had more comorbidities than those with NO-CDI. After adjustment for covariates, C-CDI and P-CDI had significantly lower HRQoL relative to NO-CDI for mental (MCS 39, 43 vs. 46) and physical (PCS 39, 41 vs. 46) component summary scores, and health utility (SF-6D 0.58, 0.64 vs. 0.71) (all p < 0.05), meeting common thresholds for minimally important differences. Those with C-CDI and P-CDI reported missing more work (21, 16 vs. 8%), greater impairment while working (43, 34 vs. 22%), and more activity impairment (61, 49 vs. 34%) than those with NO-CDI (all p < 0.05), respectively.ConclusionsCDI is associated with meaningfully worse HRQoL and greater impairment to work and activities compared with NO-CDI. The impairment directly attributable to CDI requires further evaluation.

Health economic evaluations comparing faecal microbiota transplantation with antibiotics for treatment of recurrent Clostridioides difficile infection: a systematic review

“…A larger difference in utility weights between healthy patients and patients with CDI would, therefore, lead to FMT being even more cost-effective than concluded in most of the studies. However, a multinational study by Heinrich et al [ 35 ] based on the 36-item Short Form Health Survey (SF-36) found a utility weight of 0.58 and 0.64 in patients with a current and previous CDI episode, respectively. This difference between CDI and “healthy” patients is smaller than the differences applied in most of the health economic evaluations.…”

Epidemiology of Gastrointestinal Diseases

“…Factors that contribute to higher CDI incidence in the elderly include changes in fecal microbiome, immune senescence, reduced gastric acid production, prolonged antibiotic use, and increased hospitalization and immobilization rates. The presentation of CDI is similar in older and younger adults, but older adults may have a greater impact on quality of life due to decreased mobility, visual impairment, dementia, and other comorbidities (Heinrich et al 2018). In the United States, almost half a million people develop CDI yearly, with about 20% having at least one recurrence and 5% die within 30 days after initial diagnosis (Lessa et al 2015).…”

Perception of quality of life in people experiencing or having experienced a Clostridioides difficile infection: a US population survey

“…They were performed on a limited number of patients (n = 15 and n = 24 respectively) and used a qualitative approach (interviews of patients with open-ended questions). In Heinrich et al [16], authors used the SF-36v2 (Short Form 36-item Health Survey, version 2), a generic patient-reported outcome measure quantifying health-related quality of life. More recently, in Barbut et al [17], the impact on patients was measured with the European Quality of life -5 Dimensions -3 Levels of severity (EQ-5D-3 L) a widely-used generic questionnaire.…”