Health Care Resources Cost Recurrent C. difficile Patients More

Stephen Marcella, MD, MPH, Merck Pharmaceuticals

Stephen Marcella, MD, MPH

The health care resource utilization costs linked to Clostridium difficile (C. difficile) are substantial and are necessary to help reduce the burden of C. difficile, according to a recent study.

Researchers from Merck & Co. in Kenilworth, New Jersey, retrospectively observed more than 55,000 C. difficile patients in order to estimate the health care resource utilization and costs linked to primary C. difficile and recurrent C. difficile. The patients were then matched to otherwise healthy patients. The study authors wrote that the cost of C. difficile was estimated at $5.4 billion in the US, of which $4.7 billion incurred in health care settings and the rest incurred in the community. This mostly stems from hospitalization and recurrence, they added, and recurrence incurs additional excessive costs because of hospitalization duration and intensive care unit admittance.

The patients had a mean age of 61.3 years and nearly two-thirds of them were female. A third of the patients resided in the North Central region of the US while another third came from the South region. The researchers also noted that 64% of the C. difficile patients had used antibiotics prior to their primary episode.

The patients had 0.6 hospitalizations, 0.2 emergency department visits and 4.7 doctor office visit during the 3 months prior to the primary episode on average, the researchers discovered.

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. Researchers wrote that health care costs of $24,205 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. This is because medically fragile persons are less able to handle a repeated episode of debilitating infectious diarrhea. We were surprised though at the magnitude of the difference.”

This retrospective analysis demonstrates that improvements in prevention and treatment of C. difficile, especially recurrent cases, are needed, the study authors wrote. Recurrent C. difficile has been linked to substantial health care resource use compared to primary episodes; these recurrent cases in patients who are immunocompromised or are older incur an even greater need for health care resources.

“The implications are that recurrence affects patients quite differently depending on their baseline health status as well as their risk for a recurrence of C. difficile infection,” Marcella concluded.

The paper, titled “Attributable Healthcare Resource Utilization and Costs for Patients With Primary and Recurrent Clostridium difficile Infection in the United States,” was published in the journal Clinical Infectious Diseases.