The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study.
BACKGROUND High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making. OBJECTIVE To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective. METHODS We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars. RESULTS We identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0-107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192-$36,005), $34,843 ($29,298-$40,027), and $37,171 ($30,364-$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221-$22,609), $26,074 ($25,180-$27,014), and $29,944 ($28,873-$31,086), respectively. CONCLUSIONS Hospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease. Infect Control Hosp Epidemiol 2016;37:1068-1078.
1Leslie Dan Faculty of Pharmacy,University of Toronto,Toronto,Canada.
Natasha
N
Nanwa
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Jeffrey C
JC
Kwong
1Leslie Dan Faculty of Pharmacy,University of Toronto,Toronto,Canada.
Murray
M
Krahn
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Nick
N
Daneman
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Hong
H
Lu
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Peter C
PC
Austin
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Anand
A
Govindarajan
3Institute for Clinical Evaluative Sciences,Toronto,Canada.
Laura C
LC
Rosella
1Leslie Dan Faculty of Pharmacy,University of Toronto,Toronto,Canada.
Suzanne M
SM
Cadarette
2Toronto Health Economics and Technology Assessment Collaborative,Toronto,Canada.
Beate
B
Sander
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003015:Clostridium Infections / Q000191:economics*; D015331:Cohort Studies; D003428:Cross Infection / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D055815:Young Adult