title: Incidence and Costs of Clostridium difficile Infections in Canada.
abstract: Background.  Limited data are available on direct medical costs and lost productivity due to Clostridium difficile infection (CDI) in Canada. Methods.  We developed an economic model to estimate the costs of managing hospitalized and community-dwelling patients with CDI in Canada. The number of episodes was projected based on publicly available national rates of hospital-associated CDI and the estimate that 64% of all CDI is hospital-associated. Clostridium difficile infection recurrences were classified as relapses or reinfections. Resource utilization data came from published literature, clinician interviews, and Canadian CDI surveillance programs, and this included the following: hospital length of stay, contact with healthcare providers, pharmacotherapy, laboratory testing, and in-hospital procedures. Lost productivity was considered for those under 65 years of age, and the economic impact was quantified using publicly available labor statistics. Unit costs were obtained from published sources and presented in 2012 Canadian dollars. Results.  There were an estimated 37 900 CDI episodes in Canada in 2012; 7980 (21%) of these were relapses, out of a total of 10 900 (27%) episodes of recurrence. The total cost to society of CDI was estimated at $281 million; 92% ($260 million) was in-hospital costs, 4% ($12 million) was direct medical costs in the community, and 4% ($10 million) was due to lost productivity. Management of CDI relapses alone accounted for $65.1 million (23%). Conclusions.  The largest proportion of costs due to CDI in Canada arise from extra days of hospitalization. Interventions reducing the severity of infection and/or relapses leading to rehospitalizations are likely to have the largest absolute effect on direct medical costs.
authors.affiliation: Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada ; Oxford Outcomes Ltd , Vancouver , Canada.
authors.forename: Adrian R
authors.initials: AR
authors.lastname: Levy
authors.affiliation: Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada.
authors.forename: Shelagh M
authors.initials: SM
authors.lastname: Szabo
authors.affiliation: Department of Community Health and Epidemiology , Dalhousie University , Halifax, Nova Scotia , Canada.
authors.forename: Greta
authors.initials: G
authors.lastname: Lozano-Ortega
authors.affiliation: St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada.
authors.forename: Elisa
authors.initials: E
authors.lastname: Lloyd-Smith
authors.affiliation: St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada ; University of British Columbia , Vancouver , Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Leung
authors.affiliation: Cubist Pharmaceuticals , Toronto, Ontario , Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Lawrence
authors.affiliation: St Paul's Hospital, Providence Health Care , Vancouver, British Columbia , Canada ; University of British Columbia , Vancouver , Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Romney
keywords: Clostridium difficile; economic burden; epidemiology; hospital-acquired infections; model