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A Comprehensive Study of Costs Associated With Recurrent Clostridium difficile Infection

Published online by Cambridge University Press:  07 November 2016

Rodrigo Rodrigues ,
Grant E. Barber  and
Ashwin N. Ananthakrishnan
Rodrigo Rodrigues
Affiliation:
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
Grant E. Barber
Affiliation:
Harvard Medical School, Boston, Massachusetts
Ashwin N. Ananthakrishnan*
Affiliation:
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
*
Address correspondence to Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital, 165 Cambridge Street, 9th floor, Boston, MA 02114 ([email protected]).
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Abstract

BACKGROUND

Clostridium difficile infection (CDI) is the most common healthcare-associated infection and is associated with considerable morbidity. Recurrent CDI is a key contributing factor to this morbidity. Despite an estimated 83,000 recurrences annually in the United States, there are few accurate estimates of costs associated with recurrent CDI.

OBJECTIVE

We performed this study (1) to identify the health consequences of recurrent CDI including need for repeat hospitalization, intensive care unit (ICU) stay, and surgery; (2) to determine costs associated with recurrent CDI and identify determinants of such costs; and (3) to compare the outcomes and costs of recurrent CDI to those who develop reinfection.

METHODS

We identified all patients with confirmed recurrent CDI between January to December 2013 at a single referral center. Healthcare burden associated with recurrence including diagnostic testing, pharmacologic treatment, and inpatient and outpatient healthcare visits were identified in the 12 months following the first recurrence. Total healthcare costs were calculated, and the predictors of high healthcare utilization were identified.

RESULTS

Our study population included 98 patients with recurrent CDI. The median interval between the initial infection and recurrence was 37 days. The mean age of the cohort was 67 years, two-thirds were women (62%), and the mean Charlson index was 8.6. During the year following the first recurrence of CDI, each patient underwent a mean of 4.4 stool C. difficile toxin tests and received a mean of 2.5 prescriptions for oral vancomycin (range, 0–6). Most patients (84%) with recurrence had a CDI-related hospitalization, and 6% underwent colectomy. The mean total CDI-associated cost was $34,104 per patient, with hospitalization costs accounting for 68%, surgery 20%, and drug treatment 8% of this cost, respectively. Extrapolating to the United States overall, we estimate an annual cost of $2.8 billion related to recurrent CDI.

CONCLUSION

Recurrent CDI is associated with considerable morbidity and cost.

Infect Control Hosp Epidemiol 2017;38:196–202

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 196 - 202
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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