title: Cost of hospital management of Clostridium difficile infection in United States-a meta-analysis and modelling study.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain.
  
  
  METHODS
  We conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005-2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation.
  
  
  RESULTS
  The average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7-13.6) and 9.7 (90 % CI: 9.6-9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9-$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay.
  
  
  CONCLUSIONS
  This review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.
authors: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK. Shanshan.zhang@ed.ac.uk.|Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Beijing, 100081, China. Shanshan.zhang@ed.ac.uk.
authors: Shanshan
authors: S
authors: Zhang
authors: Sanofi Pasteur, Lyon, France.
authors: Sarah
authors: S
authors: Palazuelos-Munoz
authors: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
authors: Evelyn M
authors: EM
authors: Balsells
authors: Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
authors: Harish
authors: H
authors: Nair
authors: Sanofi Pasteur, Swiftwater, PA, USA.|Lesli Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors: Ayman
authors: A
authors: Chit
authors: Sanofi Pasteur, Swiftwater, PA, USA.
authors: Moe H
authors: MH
authors: Kyaw
mesh_terms: D003015:Clostridium Infections / Q000191:economics* / Q000517:prevention & control; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D017721:Hospital Costs; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D014481:United States
keywords: Clostridium Difficile; Economic analysis; Meta-analysis; Systematic review