title: [Economic burden of Clostridium difficile enterocolitis in German hospitals based on routine DRG data].
abstract: BACKGROUND
  Clostridium difficile associated diarrhea (CDAD) is not only a increasing medical but also economical problem.
  
  
  METHODS
  Data from the DRG project group of the German society for digestive and metabolic diseases (DGVS) were analyzed for CDAD. Out of 430,875 cases from 37 German hospitals 2,767 cases were grouped by having CDAD either as primary (PD) or secondary diagnosis (SD; likely to be from a hospital source) in an initial or recurring hospital stay (RD). For comparison non-CDAD cases from the same hospitals from that year where matched using propensity score matching. As endpoints we defined LOS (length of stay), difference of LOS to national average LOS, total costs per case and difference between costs and revenue for all three groups.
  
  
  RESULTS
  Patients from the PD group (n = 817) showed a mean LOS of 11.2 days compared to 8.5 days for the control group, 4,132 € mean cost per case (536 € more than control) and a mean loss of -1,064 € per case compared to -636 €. In the SD group (n = 1,840) patients stayed in the hospital for 28.8 days (control: 18.1 days), had costs of 19,381 € (control: 13,082 €) and a loss of -3,442 € compared to -849 € in the control group. Recurring cases (RD; n = 110) showed a LOS of 37.3 days (control: 21.3 days), had even higher costs (20.755 € vs. 13,101 €) and higher losses (-4,196 € vs. -1,109 €).
  
  
  CONCLUSIONS
  By extrapolating these findings CDAD not only harms patients but generates a yearly cost burden of 464 million € for the German healthcare system including a loss of 197 million € for German hospitals. To the authors' opinion sufficient measures against CDAD should include pre hospital risk reduction programs, introduction of effective therapeutic and hygienic strategies in hospitals as well as improvements in documentation for these cases to support further developments of the German DRG system.
authors.affiliation: Dr. Wilke GmbH, München.
authors.forename: R F
authors.initials: RF
authors.lastname: Grube
authors.affiliation: Dr. Wilke GmbH, München.
authors.forename: W
authors.initials: W
authors.lastname: Heinlein
authors.affiliation: Dr. Wilke GmbH, München.
authors.forename: H
authors.initials: H
authors.lastname: Scheffer
authors.affiliation: Dr. Wilke GmbH, München.
authors.forename: M
authors.initials: M
authors.lastname: Rathmayer
authors.affiliation: Klinik für Gastroenterologie, Hepatologie und Gastroenterologische Onkologie, Städt. Klinikum München - Klinikum Bogenhausen.
authors.forename: W
authors.initials: W
authors.lastname: Schepp
authors.affiliation: I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf.
authors.forename: A W
authors.initials: AW
authors.lastname: Lohse
authors.affiliation: Klinik für Innere Medizin IV, Universitätsklinikum Jena.
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
authors.forename: M H
authors.initials: MH
authors.lastname: Wilke
authors.forename: M M
authors.initials: MM
authors.lastname: Lerch
mesh_terms: D017677:Age Distribution; D016360:Clostridioides difficile / Q000302:isolation & purification; D017281:Cost of Illness; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000382:microbiology; D003953:Diagnosis-Related Groups / Q000191:economics* / Q000706:statistics & numerical data; D004761:Enterocolitis, Pseudomembranous / Q000191:economics* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution