Attributable Cost ofClostridium difficileInfection in Pediatric Patients

Abstract

OBJECTIVES The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children. DESIGN AND METHODS We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score-matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost. RESULTS We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days. CONCLUSIONS Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost. Infect Control Hosp Epidemiol 2017;38:1472-1477.

Incidence and Outcomes Associated WithClostridium difficileInfections

“…88 Pediatric patients were included in 3 of these studies. 66,86,87 Among the 13 propensity score-matched studies of adults, the CDI-associated mean difference in LOS (in days) between patients with CDI and patients who did not have CDI varied greatly from 3.0 days (95% CI, 1.44-4.63 days) 79 to 10.3 days. 54 Among the 3 pediatric propensity score-matched studies, 66,86,87 Among the studies that used multistate models to account for timing of infection, a study 91 performed in the Veterans Affairs health care system found that the magnitude of its estimated impact was smaller when methods were used to account for the time-varying nature of infection.…”

Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

“…However, the exact exposure time often cannot be gleaned from routinely collected clinical data [4, 12]. Given this limitation, some authors have proposed matching (or adjusting) for total length of stay [12, 19]. This approach, however, is problematic as it is subject to “conditioning on the future”, i.e.…”

“…First, we presented a sensitivity analysis in which the time-dependency of exposure in HAP is ignored in order to quantify the potential overestimation of the true effect [33]. Next we conducted an analysis that was done when the exposure time was still unavailable [19, 34]. Specifically, we again ignored the time-dependency of exposure, and rather adjusted for total length of stay.…”

Risk factors for community-associated Clostridioides difficile infection in young children

“…Children have not been thought to be a particularly high-risk population for C. difficile infection (CDI). However, the severity and incidence of CDI-related hospitalisations have increased in both paediatric and adult populations [4–6], and CDI-related hospitalisations are associated with higher costs and longer length of stay [7–10]. Asymptomatic colonisation with C. difficile occurs at much higher rates in infants aged <1 year than in adults [11] but decreases rapidly after the first year of life [12].…”