title: The economic impact of Clostridium difficile infection: a systematic review.
abstract: OBJECTIVE
  With Clostridium difficile infection (CDI) on the rise, knowledge of the current economic burden of CDI can inform decisions on interventions related to CDI. We systematically reviewed CDI cost-of-illness (COI) studies.
  
  
  METHODS
  We performed literature searches in six databases: MEDLINE, Embase, the Health Technology Assessment Database, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, and EconLit. We also searched gray literature and conducted reference list searches. Two reviewers screened articles independently. One reviewer abstracted data and assessed quality using a modified guideline for economic evaluations. The second reviewer validated the abstraction and assessment.
  
  
  RESULTS
  We identified 45 COI studies between 1988 and June 2014. Most (84%) of the studies were from the United States, calculating costs of hospital stays (87%), and focusing on direct costs (100%). Attributable mean CDI costs ranged from $8,911 to $30,049 for hospitalized patients. Few studies stated resource quantification methods (0%), an epidemiological approach (0%), or a justified study perspective (16%) in their cost analyses. In addition, few studies conducted sensitivity analyses (7%).
  
  
  CONCLUSIONS
  Forty-five COI studies quantified and confirmed the economic impact of CDI. Costing methods across studies were heterogeneous. Future studies should follow standard COI methodology, expand study perspectives (e.g., patient), and explore populations least studied (e.g., community-acquired CDI).
authors.affiliation: 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada.
authors.forename: Natasha
authors.initials: N
authors.lastname: Nanwa
authors.affiliation: 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tetyana
authors.initials: T
authors.lastname: Kendzerska
authors.affiliation: 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada [3] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [4] Department of Medicine, University of Toronto, Toronto, Ontario, Canada [5] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [6] University Health Network, Toronto, Ontario, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
authors.affiliation: 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] University Health Network, Toronto, Ontario, Canada [3] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada [4] Public Health Ontario, Toronto, Ontario, Canada [5] Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.affiliation: 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Department of Medicine, University of Toronto, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Daneman
authors.affiliation: CHU de Quebec University, Quebec City, Quebec, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Witteman
authors.affiliation: 1] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada [2] Health Outcomes and PharmacoEconomic Research Centre, Toronto, Ontario, Canada [3] Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada [4] Richard Ivey School of Business, University of Western Ontario, London, Ontario, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
authors.affiliation: 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada [3] Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Rosella
authors.affiliation: 1] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada [2] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Public Health Ontario, Toronto, Ontario, Canada.
authors.forename: Beate
authors.initials: B
authors.lastname: Sander
mesh_terms: D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004761:Enterocolitis, Pseudomembranous / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans
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