title: The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program.
abstract: OBJECTIVE
  To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals
  
  
  METHODS
  Markov model with a 5-year time horizon
  
  
  METHODS
  Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old.
  
  
  BACKGROUND
  CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012.
  
  
  METHODS
  Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials. RESULTS In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion).
  
  
  CONCLUSIONS
  The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Slayton
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Scott
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: James
authors.initials: J
authors.lastname: Baggs
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Lessa
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
authors.affiliation: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D008390:Markov Chains; D054539:Medication Therapy Management / Q000706:statistics & numerical data; D009313:National Health Programs; D017751:Safety Management / Q000191:economics / Q000379:methods; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents