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A Comprehensive Study of Costs Associated With Recurrent Clostridium difficile Infection

  • Rodrigo Rodrigues (a1), Grant E. Barber (a2) and Ashwin N. Ananthakrishnan (a1) (a2)

Abstract

BACKGROUND

Clostridium difficile infection (CDI) is the most common healthcare-associated infection and is associated with considerable morbidity. Recurrent CDI is a key contributing factor to this morbidity. Despite an estimated 83,000 recurrences annually in the United States, there are few accurate estimates of costs associated with recurrent CDI.

OBJECTIVE

We performed this study (1) to identify the health consequences of recurrent CDI including need for repeat hospitalization, intensive care unit (ICU) stay, and surgery; (2) to determine costs associated with recurrent CDI and identify determinants of such costs; and (3) to compare the outcomes and costs of recurrent CDI to those who develop reinfection.

METHODS

We identified all patients with confirmed recurrent CDI between January to December 2013 at a single referral center. Healthcare burden associated with recurrence including diagnostic testing, pharmacologic treatment, and inpatient and outpatient healthcare visits were identified in the 12 months following the first recurrence. Total healthcare costs were calculated, and the predictors of high healthcare utilization were identified.

RESULTS

Our study population included 98 patients with recurrent CDI. The median interval between the initial infection and recurrence was 37 days. The mean age of the cohort was 67 years, two-thirds were women (62%), and the mean Charlson index was 8.6. During the year following the first recurrence of CDI, each patient underwent a mean of 4.4 stool C. difficile toxin tests and received a mean of 2.5 prescriptions for oral vancomycin (range, 0–6). Most patients (84%) with recurrence had a CDI-related hospitalization, and 6% underwent colectomy. The mean total CDI-associated cost was $34,104 per patient, with hospitalization costs accounting for 68%, surgery 20%, and drug treatment 8% of this cost, respectively. Extrapolating to the United States overall, we estimate an annual cost of $2.8 billion related to recurrent CDI.

CONCLUSION

Recurrent CDI is associated with considerable morbidity and cost.

Infect Control Hosp Epidemiol 2017;38:196–202

Copyright

Corresponding author

Address correspondence to Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital, 165 Cambridge Street, 9th floor, Boston, MA 02114 (aananthakrishnan@mgh.harvard.edu).

References

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1. Ananthakrishnan, AN. Clostridium difficile infection: epidemiology, risk factors and management. Nat Rev Gastroenterol Hepatol 2011;8:1726.
2. Dubberke, ER, Wertheimer, AI. Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:5766.
3. Kelly, CP. A 76-year-old man with recurrent Clostridium difficile-associated diarrhea: review of C. difficile infection. JAMA 2009;301:954962.
4. Pepin, J, Valiquette, L, Alary, ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466472.
5. Rupnik, M, Wilcox, MH, Gerding, DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol 2009;7:526536.
6. Wilcox, MH, Cunniffe, JG, Trundle, C, Redpath, C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:2330.
7. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825834.
8. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.
9. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:11981208.
10. Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 2002;34:346353.
11. Mergenhagen, KA, Wojciechowski, AL, Paladino, JA. A review of the economics of treating Clostridium difficile infection. PharmacoEconomics 2014;32:639650.
12. Garey, KW, Sethi, S, Yadav, Y, DuPont, HL. Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect 2008;70:298304.
13. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403410.
14. McFarland, LV, Elmer, GW, Surawicz, CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:17691775.
15. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478498; quiz 499.
16. Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422431.
17. Lowy, I, Molrine, DC, Leav, BA, et al. Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010;362:197205.
18. van Nood, E, Speelman, P, Kuijper, EJ, Keller, JJ. Struggling with recurrent Clostridium difficile infections: Is donor faeces the solution? Euro Surveill 2009;14:pii:19316.
19. van Nood, E, Vrieze, A, Nieuwdorp, M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile . N Engl J Med 2013;368:407415.
20. Aslam, S, Musher, DM. An update on diagnosis, treatment, and prevention of Clostridium difficile-associated disease. Gastroenterol Clin North Am 2006;35:315335.
21. Debast, SB, Bauer, MP, Kuijper, EJ, European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20(Suppl 2):126.
22. Konijeti, GG, Sauk, J, Shrime, MG, Gupta, M, Ananthakrishnan, AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis 2014;58:15071514.
23. Varier, RU, Biltaji, E, Smith, KJ, et al. Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection. Clin Microbiol Infect 2014;20:13431351.
24. Ghantoji, SS, Sail, K, Lairson, DR, DuPont, HL, Garey, KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 2010;74:309318.
25. Le Monnier, A, Duburcq, A, Zahar, JR, et al. Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals. J Hosp Infect 2015;91:117122.
26. McFarland, LV, Surawicz, CM, Rubin, M, Fekety, R, Elmer, GW, Greenberg, RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999;20:4350.
27. Miller, MA, Hyland, M, Ofner-Agostini, M, Gourdeau, M, Ishak, M. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol 2002;23:137140.
28. Shah, DN, Aitken, SL, Barragan, LF, et al. Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study. J Hosp Infect 2016;93:286289.
29. Khanna, S, Pardi, DS, Aronson, SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:8995.
30. Wen, J, Barber, GE, Ananthakrishnan, AN. Identification of recurrent Clostridium difficile infection using administrative codes: accuracy and implications for surveillance. Infect Control Hosp Epidemiol 2015;36:893898.
31. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.
32. Abou Chakra, CN, Pepin, J, Sirard, S, Valiquette, L. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLoS One 2014;9:e98400.
33. Aslam, S, Hamill, RJ, Musher, DM. Treatment of Clostridium difficile–associated disease: old therapies and new strategies. Lancet Infect Dis 2005;5:549557.
34. Pepin, J, Alary, ME, Valiquette, L, et al. Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 2005;40:15911597.
35. Bauer, MP, van Dissel, JT, Kuijper, EJ. Clostridium difficile: controversies and approaches to management. Curr Opin Infect Dis 2009;22:517524.
36. Aitken, SL, Joseph, TB, Shah, DN, et al. Healthcare resource utilization for recurrent Clostridium difficile infection in a large university hospital in Houston, Texas. PLoS One 2014;9:e102848.
37. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55:S88S92.
38. Dubberke, ER, Reske, KA, Olsen, MA, McDonald, LC, Fraser, VJ. Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497504.
39. O’Brien, JA, Lahue, BJ, Caro, JJ, Davidson, DM. The emerging infectious challenge of Clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:12191227.
40. Song, X, Bartlett, JG, Speck, K, Naegeli, A, Carroll, K, Perl, TM. Rising economic impact of clostridium difficile-associated disease in adult hospitalized patient population. Infect Control Hosp Epidemiol 2008;29:823828.
41. Olsen, MA, Yan, Y, Reske, KA, Zilberberg, M, Dubberke, ER. Impact of Clostridium difficile recurrence on hospital readmissions. Am J Infect Control 2015;43:318322.
42. McFarland, LV. Renewed interest in a difficult disease: Clostridium difficile infections—epidemiology and current treatment strategies. Curr Opin Gastroenterol 2009;25:2435.
43. Lapointe-Shaw, L, Tran, KL, Coyte, PC, et al. Cost-effectiveness analysis of six strategies to treat recurrent Clostridium difficile infection. PLoS One 2016;11:e0149521.
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