1386. The Economic Burden of Clostridium difficile-associated Diarrhea: A Retrospective Study of Acute Care Hospital Inpatients, 2009-2011
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
The Economic Burden of Clostridium difficile-associated Diarrhea: A Retrospective Study of Acute Care Hospital Inpatients, 2009-2011

Background: Evaluate the economic burden and selected clinical outcomes for patients with Clostridium difficile-associated diarrhea (CDAD) compared to similar populations without CDAD using a retrospective cohort study design.

Methods: Inpatients ≥18 discharged between 2009-2011 with a CDAD diagnosis and receiving CDAD treatment (vancomycin, fidaxomicin, or metronidazole) during hospitalization were selected from the Premier research database. Non-CDAD patients were chosen using an exact match on discharge year and MS-DRG and propensity matching on patient demographics and comorbidities. The overall CDAD vs. non-CDAD population was analyzed for all cause readmissions, total hospital costs, total and ICU length of stay (LOS), and inpatient mortality. Multivariate models were employed to further adjust for patient variation remaining after the matching process.

Results: After applying exclusion and matching criteria, 84,225 CDAD patients were compared to 84,918 non-CDAD patients for the overall population. Patient demographics were well balanced between groups (mean age 68 years, 55% female, 66%-68% white).  After matching, 30 and 60 day all cause readmission rates were significantly greater for CDAD patients vs. non-CDAD patients (23.2% and 30.4% vs. 14.8% and 19.7%, respectively, all P<0.0001) and inpatient mortality was significantly elevated as well (10.4% vs. 8.0%, respectively, P<0.001).  Multivariate models demonstrated similar results. CDAD patients had significantly greater risks of 30 and 60 day readmissions compared to non-CDAD patients (OR’s, 95% CI:  1.77, 1.73-1.82 and 1.83, 1.79-1.87, respectively), and a significantly elevated risk of inpatient mortality (OR 1.13, 95% CI: 1.09-1.17).  Other risk-adjusted outcomes were also significantly higher for CDAD patients; total LOS was 13.2 vs. 8.5 days; ICU LOS was 8.3 vs. 6.6 days, and total hospital costs were $25,804 vs. $18,518, respectively; all P<0.001.

Conclusion: This analysis of patients with CDAD showed an increased economic burden to hospitals based on greater numbers of readmissions, LOS, and hospital costs when compared with similar non-CDAD patients overall.

Glenn Magee, MBA, Premier Research Services, Premier, Inc., Charlotte, NC, Harold Brown, MHA / MBA, Premier Research Services, Premier, Inc, Charlotte, NC, Marcie Strauss, MPH, Health Economics & Outcomes Research, Optimer Pharmaceuticals, Inc., Jersey City, NJ and Sheila Thomas, PharmD, Optimer Pharmaceuticals, Inc, Jersey City, NJ

Disclosures:

G. Magee, None

H. Brown, None

M. Strauss, Optimer Pharmaceuticals, Inc.: Employee and Shareholder, Consulting fee and Salary

S. Thomas, Optimer Pharmaceuticals, Inc.: Employee, Salary

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