Economic Barriers in the Treatment of Clostridium difficile Infection With Oral Vancomycin

Bunnell, Kristen; Danziger, Larry H.; Johnson, Stuart

doi:10.1093/ofid/ofx078

Cited by 17 publications

(22 citation statements)

References 8 publications

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“…Vancomycin capsules were approved for treatment of CDI in 1986 [7]. At that time, the estimated cost for 10 days of vancomycin at 125 mg dosage was $160 while a 500 mg dosage was $640 [12].…”

Section: Discussionmentioning

confidence: 99%

“…At that time, the estimated cost for 10 days of vancomycin at 125 mg dosage was $160 while a 500 mg dosage was $640 [12]. In 2017, the estimated cost of 10 days of vancomycin at 125 mg dosage was $2640 while a 500 mg dosage was $9760 [7]. High dose vancomycin is not only costly but also has the potential for detectable serum concentrations in certain patient population.…”

Section: Discussionmentioning

confidence: 99%

“…He concluded that it was an "activation of a latent virus by penicillin" which caused this infection, and later it was proven that it was the C. diff cytotoxin. In 1986, vancomycin was approved by the Food and Drug administration (FDA) for treatment of CDI and was the first and only medication for CDI [3,7]. Two concerns of using vancomycin at this time were (1) cost and (2) colonization with vancomycin-resistant enterococcus.…”

Section: Introductionmentioning

confidence: 99%

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Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

et al. 2019

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Background: Oral vancomycin is a first line treatment for an initial episode of Clostridioides difficile infection. However, the comparative efficacy of different dosing regimens is lacking evidence in the current literature. Methods: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. from inception to May 2019. Only articles published in English are reviewed. This meta-analysis compares the effects of low dose oral vancomycin (<2 g per day) versus high dose vancomycin (2 g per day) for treatment of initial Clostridioides difficile infection. Results: One randomized controlled trial and two retrospective cohort studies are included. A total of 137 patients are identified, 53 of which were treated with low dose oral vancomycin (39%) and 84 with high dose oral vancomycin (61%). There is no significant reduction in recurrence rates with high dose vancomycin compared to low dose vancomycin for treating initial episodes of non-fulminant Clostridioides difficile infection ((odds ratio (OR) 2.058, 95%, confidence interval (CI): 0.653 to 6.489). Conclusions: Based on limited data in the literature, low dose vancomycin is no different than high dose vancomycin for treatment of an initial episode of Clostridioides difficile infection in terms of recurrence rate. Additional large clinical trials comparing the different dosages of vancomycin in initial Clostridioides difficile infection are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

et al. 2019

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“…Challenges may include financial constraints to completing the full antibiotic course, especially as the most common treatments for CDI, oral vancomycin and fidaxomicin, can be prohibitively expensive for uninsured patients [7,8]. Other challenges may include inability to manage environmental cleaning to reduce re-infection and spore shedding, and lack of resources such as transportation and social support to facilitate follow-up care [7,9]. Household crowding, a common indicator of socioeconomic disadvantage, has also been linked to poorer outcomes for infectious disease patients [10].…”

Section: Introductionmentioning

confidence: 99%

Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

et al. 2020

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Background Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as ‘neighborhood’ socioeconomic disadvantage, on a CDI patient’s health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient’s ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. Methods In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. Results From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). Conclusions Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.

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“…With an average of 5 patients per month avoiding oral vancomycin treatments, each of which cost~$1,000 per course, we estimated a further average savings postintervention of~$5,000 per month from drug costs avoided. 8…”

Section: Resultsmentioning

confidence: 99%

Reducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship

Yen

Holtom

Butler-Wu

et al. 2018

Infect. Control Hosp. Epidemiol.

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We conducted a quality improvement project at a large public tertiary-care academic hospital to reduce reported hospital-acquired Clostridium difficile infection (CDI) rates. We introduced diagnostic stewardship and provider education, resulting in a 2-fold reduction in C. difficile nucleic acid amplification test (NAAT) orders and markedly lower hospital CDI rate.Infect Control Hosp Epidemiol 2018;39:734-736.

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Economic Barriers in the Treatment of Clostridium difficile Infection With Oral Vancomycin

Cited by 17 publications

References 8 publications

Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

Reducing Clostridium difficile Colitis Rates Via Cost-Saving Diagnostic Stewardship

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