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Attributable Cost of Clostridium difficile Infection in Pediatric Patients

Published online by Cambridge University Press:  27 November 2017

Preeti Mehrotra ,
Jisun Jang ,
Courtney Gidengil  and
Thomas J. Sandora
Preeti Mehrotra*
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts
Jisun Jang
Affiliation:
Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Courtney Gidengil
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts RAND Corporation, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts
*
Address correspondence to Preeti Mehrotra, MD, Division of Infectious Diseases, Boston Children’s Hospital, 320 Longwood Avenue, Boston, MA 02115 (pmehrotr@bidmc.harvard.edu).
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Abstract

OBJECTIVES

The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children.

DESIGN AND METHODS

We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score–matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost.

RESULTS

We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days.

CONCLUSIONS

Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost.

Infect Control Hosp Epidemiol 2017;38:1472–1477

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1472 - 1477
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. This work was previously presented at the Society for Healthcare Epidemiology of America: Science Guiding Prevention 2015 conference in Orlando, Florida, on May 15, 2015.

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