1388. The Economic Burden of Clostridium difficile infection in Canada
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Limited data are available on the costs of Clostridium difficile infection (CDI) in Canada. The objective was to estimate direct medical costs and lost productivity due to CDI in Canada in 2012.

Methods: We developed an economic model in order to estimate the costs of managing hospitalized and community-dwelling patients with CDI in Canada.  The number of episodes in 2012 was projected based on publicly-available national rates of hospital-associated CDI, and the estimate that 64% of all CDI is hospital-associated. CDI recurrences were classified as relapses (occurring two to eight weeks after previous episode) or reinfections (more than eight weeks after previous episode). Resource utilization data came from published literature, clinician interviews, data from Providence Health Care (Vancouver) and from other Canadian CDI surveillance programs, and included: hospital length of stay, contact with health care providers, pharmacotherapy, CDI and other laboratory testing, and in-hospital procedures. Lost productivity while in hospital was considered for those less than 65 years of age, and the economic impact quantified using publically-available labor statistics. Unit costs were obtained from published sources, and all costs were presented in 2012 Canadian dollars (CAD).

Results: There were an estimated 37,900 CDI episodes in Canada in 2012, 10,900 (29%) of which were recurrence.  Of recurrent episodes, 7,980 (73%) were estimated to be relapses. The total cost to society of CDI was estimated at $281 million, of which 92% ($260 million) was in-hospital costs, 4% ($12 million) direct medical costs in the community, and 4% ($10 million) due to lost productivity. Management of all CDI recurrences cost over $80 million CAD, with CDI relapses accounting for $65.1 million (23%). 

Conclusion: The largest proportion of costs due to CDI in Canada arise from extra days of hospitalization.  Interventions reducing the severity of infection (such that length of stay and need for intensive care is reduced) and/or relapses leading to rehospitalizations are likely to have the largest absolute effect on the direct medical costs accrued by hospitals.

Adrian Levy, PhD1, Shelagh Szabo, MSc1, Greta Lozano-Ortega1, Elisa Lloyd-Smith, PhD2, Victor Leung, MD, FRCPC2 and Marc G. Romney, MD, FRCPC, DTM&H3, (1)Oxford Outcomes, Vancouver, BC, Canada, (2)Providence Health Care, Vancouver, BC, Canada, (3)Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC, Canada


A. Levy, Oxford Outcomes: Consultant, Consulting fee

S. Szabo, None

G. Lozano-Ortega, None

E. Lloyd-Smith, None

V. Leung, None

M. G. Romney, Pfizer: Grant Investigator and Scientific Advisor, Consulting fee and Research grant

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