Significant Costs Linked to Hospital-Acquired C. Difficile

Jenine Leal

A new look at Clostridioides difficile infections (CDI) shows substantial costs, as well as increased hospital stays when the infection is acquired in the hospital.

A team led by Jenine Leal, a PhD candidate at the University of Calgary, used three different forms of data—linked clinical, administrative, and microcosting data—in a retrospective, population-based, propensity-score-matched cohort study to determine the attributable cost and length of stays for patients with hospital-acquired Clostridioides difficile infections (HA-CDI).

“In this population-based, propensity score matched analysis using microcosting data, HA-CDI was associated with substantial attributable cost,” the authors wrote.

In the study, which took place in acute-care facilities in Alberta, Canada, investigators examined adult patients both with HA-CDI and without CDI between April 1, 2012 and March 31, 2016.

The HA-CDI patients were identified using a clinical surveillance definition and then matched to noncases of CDI—patients without a positive C. difficile test or without clinical CDI—on the propensity score and exposure time.

The team identified 2916 HA-CDI cases at facilities with microcosting data available. They then matched 98.4% of these cases to 13,024 noncases of CDI with a total adjusted cost 27% greater among HA-CDI than noncases of CDI and an adjusted length of stay among HA-CDI cases 13% greater than noncases of CDI.

The mean attributable cost of HA-CDI was $14,190 and the average extra length of hospital stays was 5.6 days per HA-CDI case.

In 2018, investigators from Merck & Co., Kenilworth, New Jersey, examined data from more than 55,000 C. difficile patients matched with to estimate the time and costs linked to both primary C. diff and recurrent C. difficile.

The team estimated the cost of C. difficile to be about $5.4 billion in the US, $4.7 billion of which was incurred in health care settings, mostly due to hospitalizations and recurrence.

A third of the patients in the Merck study resided in the North Central region of the US, while another third came from the South region. The investigators also found that 64% of the patients had used antibiotics prior to their primary episode.

Overall, the patients averaged 0.6 hospitalizations, 0.2 emergency department visits, and 4.7 doctor office visits during a 3-month period prior to the primary episode.

A quarter of the patients had recurrence, with a higher rate in patients who were female (25%), older than 65 years (28%), used antibiotics (26%) prior to their primary episode than those who were male (23%), were younger than 65 years (21%), or did not use antibiotics (22%).

The average health care cost across all patients with primary C. difficile infection was $43,718 compared to $19,513 in those patients matched without C. difficile. The $24,205 in health care costs could be attributed to primary C. difficile infection. Comparing costs in terms of settings, inpatient cost for C. difficile infection patients reached $28,014 compared to $6,918 for patients without C. difficile.

In patients with recurrent infection, the average health care cost totaled $49,456 compared to matched patients without infection at $38,876. The researchers wrote that the total health care cost attributable to recurrent C. difficile infection compared to those with primary infection only is about $10,500.

“One of the more interesting findings from this study is the difference in attributable cost and health care utilization for persons with different comorbidities,” study author Stephen Marcella, MD, MPH, Merck Pharmaceuticals, told MD Magazine®. “We hypothesized that persons with more complex illnesses (comorbidities) would suffer more from having a C. difficile infection recurrence.”

The study, “Attributable costs and length of stay of hospital-acquired Clostridioides difficile: A population-based matched cohort study in Alberta, Canada,” was published online in Infection Control & Hospital Epidemiology.