Program Schedule

US Costs and Outcomes Associated with Clostridium difficile Infections: a Systematic Literature Review, Meta-analysis, and Mathematical Model

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • C dif poster final.gif (451.8 kB)
  • Background: Information about the health and economic impact of C. difficile infections (CDI) in the US can inform investments in prevention and treatment interventions.

    Objective: To estimate the morbidity, mortality, and cost burden of CDI in the US using a systematic literature review, meta-analysis and economic model.


    We searched MEDLINE, CINAHL, Cochrane Library, NHS Economic Evaluation Database, Web of Science and Scopus for multicenter studies published in the US from 2000-2014 that evaluated CDI outcomes or costs. Studies were included in the economic analysis if they either measured post-infection costs, post-infection length of stay (LOS), or propensity score-matched CDI patients to non-CDI controls. We also included studies that evaluated CDI-associated mortality with a control group. We created an economic model using TreeAgePro 2014. We used gamma distributions for cost estimates, beta distributions for probabilities, and lognormal distributions for relative risks. The analysis consisted of 1,000 first order simulations and 10,000 second order simulations. 

    Results: 22 studies that evaluated mortality due to CDI were pooled, and CDI was associated with a 2.5-fold increase in mortality compared with other patients (pooled RR=2.54; 95% CI: 1.89, 3.40). Only 4 low to moderate quality studies evaluated costs of CDI. The mean CDI-attributable cost of the index hospitalization ranged from $8,426 to $48,500. The mean costs per CDI after discharge were $1,592 for outpatient visits and $14,847 for readmissions. When these were adjusted to 2013 US dollars and included in the economic model, the mean total cost of a CDI was $32,198 (SD = $9,798). Of the 3 studies that evaluated LOS using propensity matching, the mean CDI-attributable LOS was 12.3 days. When this excess LOS was multiplied by an average cost per day from a private 3rd party payer perspective, CDI cost an average of $56,663 (SD =$19,804).­­


    Pooled estimates from the current literature suggest that CDI is associated with large health and economic burdens. Yet, most of the studies were of mid-to-low quality and may overestimate the outcomes, as they did not exclude pre-infection LOS and costs. These estimates should be used with caution and high quality studies should be done.

    Marin Schweizer, PhD1,2, Richard E. Nelson, PhD3, Matthew Samore, MD4, Scott D Nelson, PharmD5, Karim Khader, PhD3, Rachel Slayton, PhD, MPH6, John Jernigan, MD, MS6, Hsiu-Yin Chiang, PhD, MS1, Margaret Chorazy, Ph.D, M.P.H7, Loreen a. Herwaldt, MD, FIDSA, FSHEA1, Daniel J. Diekema, MD, FIDSA, FSHEA8, Michelle Formanek, MS9, Ashish Malhotra, MBBS MSCI10, Amy Blevins, MALS11, Melissa Ward, MS12 and Eli Perencevich, MD, MS, FIDSA, FSHEA2,12, (1)Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (2)Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, (3)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (4)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (5)College of Pharmacy, University of Utah, Salt Lake City, UT, (6)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (7)Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, (8)University of Iowa, Carver College of Medicine, Iowa City, IA, (9)Epidemiology, University of Iowa College of Public Health, Iowa City, IA, (10)Minneapolis VA Medical Center, Minneapolis, MN, (11)Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, (12)Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA


    M. Schweizer, None

    R. E. Nelson, None

    M. Samore, None

    S. D. Nelson, None

    K. Khader, None

    R. Slayton, None

    J. Jernigan, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
    Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

    H. Y. Chiang, None

    M. Chorazy, None

    L. A. Herwaldt, None

    D. J. Diekema, Forest Labs: Grant Investigator, Research grant

    M. Formanek, None

    A. Malhotra, None

    A. Blevins, None

    M. Ward, None

    E. Perencevich, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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