346. Economic Burden of Clostridium Difficile Infection Among Elderly Patients in the United States: An Analysis Using Medicare Claims Data
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1

Background:  Elderly patients represent 66% of hospital inpatients with Clostridium difficile infection (CDI) in the United States (U.S.). Health insurance claims data can be used to estimate the annual economic burden of CDI among Medicare patients.

Methods:  A retrospective analysis of claims data was performed using 2007-2008 Medicare 5% Standard Analytical Files (SAF). Patients aged 65+ with at least one CDI inpatient stay were included. CDI was identified by ICD-9-CM diagnosis code 008.45 recorded on the primary or secondary field of the inpatient claim form. Multivariate regression models estimated the increased medical costs associated with CDI, controlling for patient demographics and comorbidities. Attributable cost of CDI (2010 U.S. dollars) was evaluated for one year from the date of the first CDI hospitalization, and is reported overall and by practice setting (hospital inpatient, hospital outpatient, physician office, skilled nursing facility, home health, and hospice).

Results:  Among 108,300 Medicare patients aged 65+ with a diagnosis of CDI during an inpatient stay, 24.3% were readmitted with a CDI diagnosis within one year; of whom 70.3% had one readmission, 18.5% had two, and 11.2% had 3+ readmissions. Annual Medicare payments attributable to CDI across practice settings were $18,092 per patient, on average, and highest among patients with 3+ CDI readmissions ($34,022) compared with two, one, or no CDI readmissions ($15,443, $10,072, and $8,820, respectively). Overall, hospital inpatient payments accounted for 56.8% of the attributable cost, whereas skilled nursing facility/home health/hospice was 28.4%, and hospital outpatient/physician office was 14.8%. The estimated annual national medical expenditure across practice settings attributable to CDI is approximately $2.0 billion among elderly Medicare beneficiaries with a hospital inpatient diagnosis of CDI.

Conclusion:  Recent U.S. health care reform legislation focuses on improving quality of care and reducing costs, for example, by preventing hospital readmissions. The economic burden of CDI among Medicare beneficiaries in the U.S. is substantial and highlights the need for more targeted therapies to prevent recurrences of CDI and reduce health care expenditures.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Erik Dubberke, MD, MSPH, Washington University in St. Louis, St. Louis, MO, Yaozhu J, Chen, MPA, Covance Market Access Services Inc., Gaithersburg, MD, Stacey J. Ackerman, MSE, PhD, Covance Market Access Services Inc., San Diego, CA, Robert Owens, PharmD, Cubist Pharmaceuticals, Lexington, MA and Stuart Johnson, MD, Edward Hines Jr. Veterans Affair Hospital, Maywood, IL


E. Dubberke, Optimer Pharmaceuticals Inc. : Research Contractor and Scientific Advisor, Consulting fee and Research support
Merck: Consultant and Research Contractor, Consulting fee and Research support
Pfizer: Scientific Advisor, Consulting fee
Schering-Plough: Speaker's Bureau, Speaker honorarium

Y. J. Chen, Optimer Pharmaceuticals Inc: Consultant, Consulting fee

S. J. Ackerman, Optimer Pharmaceuticals Inc.: Consultant, Consulting fee

R. Owens, Optimer Pharmaceuticals Inc.: Consultant, Consulting fee
Cubist Pharmaceuticals: Employee and Shareholder, Salary

S. Johnson, Optimer Pharmaceuticals: Consultant, Consulting fee
ViroPharma: Consultant, Consulting fee
Astellas: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Cubist: Consultant, Consulting fee
Bio-K+: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.