title: Hospitalized Patients with Cirrhosis Should Be Screened for Clostridium difficile Colitis.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is an important public health problem in hospitalized patients. Patients with cirrhosis are particularly at risk of increased associated morbidity, mortality, and healthcare utilization from CDI.
  
  
  OBJECTIVE
  The aim of this study was to assess the pharmacoeconomic impact of CDI screening on hospitalized patients with cirrhosis.
  
  
  METHODS
  A Markov model was used to compare costs and outcomes of two strategies for the screening of CDI. The first strategy consisted of screening all patients for CDI and treating if detected (screening). In the second strategy, only patients found to have symptomatic CDI were treated (no screening). The probability of underlying CDI prevalence, symptomatic CDI infection, and likelihood of recurrent infection were varied in a sensitivity analysis. The costs of antibiotics and hospitalization were also assessed. Differences in outcome were expressed in ratio of the total costs associated with screening to the total costs associated without screening.
  
  
  RESULTS
  The results of our model showed that screening for CDI was consistently associated with improved healthcare outcomes and decreased healthcare utilization across all variables in the one- and two-way sensitivity analyses. Using baseline assumptions, the costs associated with the no screening strategy were 3.54 times that of the screening strategy. Moreover, the mortality for symptomatic CDI was lower in the screening strategy than the no screening strategy.
  
  
  CONCLUSIONS
  The screening strategy results in less healthcare utilization and improved clinical outcomes. Screening for CDI measures favorably.
authors.affiliation: Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA. SSaab@mednet.ucla.edu.|Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA. SSaab@mednet.ucla.edu.|Pfleger Liver Institute, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA. SSaab@mednet.ucla.edu.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Alper
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Sernas
authors.affiliation: Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Paridhima
authors.initials: P
authors.lastname: Pruthi
authors.affiliation: Gastroenterogy Associates, Fresno, CA, USA.
authors.forename: Mikhail A
authors.initials: MA
authors.lastname: Alper
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sundaram
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000191:economics; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D018570:Risk Assessment
keywords: Asymptomatic carriers; C. Difficile screening; Cost-effectiveness; Hospitalized patients