title: Economic burden of Clostridium difficile in five hospitals of the Florence health care system in Italy.
abstract: BACKGROUND
  Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication.
  
  
  METHODS
  We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI.
  
  
  RESULTS
  We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature.
  
  
  CONCLUSIONS
  The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice.
authors.affiliation: Vigilanza e Controllo Infezioni Correlate all'Assistenza, Ospedale Piero Palagi, Azienda Sanitaria di Firenze, Firenze, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Poli
authors.affiliation: SAVE Studi - Health Economics and Outcomes Research, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Di Matteo
authors.affiliation: SAVE Studi - Health Economics and Outcomes Research, Milan, Italy.
authors.forename: Giacomo M
authors.initials: GM
authors.lastname: Bruno
authors.affiliation: Vigilanza e Controllo Infezioni Correlate all'Assistenza, Ospedale Piero Palagi, Azienda Sanitaria di Firenze, Firenze, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Fornai
authors.affiliation: SAVE Studi - Health Economics and Outcomes Research, Milan, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Valentino
authors.affiliation: SAVE Studi - Health Economics and Outcomes Research, Milan, Italy ; Department of Drug Sciences, University of Pavia, Pavia, Italy.
authors.forename: Giorgio L
authors.initials: GL
authors.lastname: Colombo
keywords: burden of disease; cost analysis; cost of illness; pharmacoeconomics