title: The economic burden of Clostridium difficile.
abstract: Although Clostridium difficile (C. difficile) is the leading cause of infectious diarrhoea in hospitalized patients, the economic burden of this major nosocomial pathogen for hospitals, third-party payers and society remains unclear. We developed an economic computer simulation model to determine the costs attributable to healthcare-acquired C. difficile infection (CDI) from the hospital, third-party payer and societal perspectives. Sensitivity analyses explored the effects of varying the cost of hospitalization, C. difficile-attributable length of stay, and the probability of initial and secondary recurrences. The median cost of a case ranged from $9179 to $11 456 from the hospital perspective, $8932 to $11 679 from the third-party payor perspective, and $13 310 to $16 464 from the societal perspective. Most of the costs incurred were accrued during a patient's primary CDI episode. Hospitals with an incidence of 4.1 CDI cases per 100 000 discharges would incur costs ≥$3.2 million (hospital perspective); an incidence of 10.5 would lead to costs ≥$30.6 million. Our model suggests that the annual US economic burden of CDI would be ≥$496 million (hospital perspective), ≥$547 million (third-party payer perspective) and ≥$796 million (societal perspective). Our results show that C. difficile infection is indeed costly, not only to third-party payers and the hospital, but to society as well. These results are consistent with current literature citing C. difficile as a costly disease.
authors.affiliation: Public Health Computational and Operations Research (PHICOR), School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. smm168@pitt.edu
authors.forename: S M
authors.initials: SM
authors.lastname: McGlone
authors.forename: R R
authors.initials: RR
authors.lastname: Bailey
authors.forename: S M
authors.initials: SM
authors.lastname: Zimmer
authors.forename: M J
authors.initials: MJ
authors.lastname: Popovich
authors.forename: Y
authors.initials: Y
authors.lastname: Tian
authors.forename: P
authors.initials: P
authors.lastname: Ufberg
authors.forename: R R
authors.initials: RR
authors.lastname: Muder
authors.forename: B Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology; D003198:Computer Simulation; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015233:Models, Statistical; D014481:United States / Q000453:epidemiology