Healthcare resource utilization and direct medical costs associated with index and recurrent <i>Clostridioides difficile</i> infection: a real-world data analysis

Feuerstadt, Paul; Stong, Laura; Dahdal, David N.; Sacks, Naomi; Lang, Kathleen; Nelson, Winnie W.

doi:10.1080/13696998.2020.1724117

Cited by 50 publications

(41 citation statements)

References 28 publications

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“…Our study is consistent with previous analyses showing higher costs for those with any rCDI compared with those with no recurrence. 24,37 However, we observed similar total costs no matter the recurrence cohort in the follow-up period. This was likely attributed to lower utilization of typically costly PAC services and higher costs for inpatient, outpatient, physician services, and drug usage in the cohorts with 2 or more recurrences.…”

Section: Discussionsupporting

confidence: 57%

“…However, many similar data trends were seen in a real-world analysis of U.S. commercial claims for patients with CDI, including time to recurrence of approximately 1 month, follow-up costs being higher for rCDI cohorts (with inpatient costs representing the majority of total costs), and rates of HRU being highest for the 3+ rCDI cohort. 24 The coverage policy of Medicare is more stringent than that of commercial insurance, and, therefore, a range of services not covered by Medicare could have been provided and paid for by the patient or supplemental insurance. Providers do not submit claims…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9] The time to recurrence across all 3 rCDI cohorts was approximately 1 month in our study, similar to data reported elsewhere. 24,25 This 4-week time period presents a known, but often not actioned, window of opportunity to modify underlying risk factors and reduce the risks for recurrence.…”

Section: Demographicsmentioning

confidence: 99%

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Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Nelson

Scott

Boules

et al. 2021

JMCP

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BACKGROUND: Clostridioides difficile infection (CDI) affected an estimated 365,000 persons in the United States in 2017. Despite a nationally decreasing trend of CDI cases, the population incidence of recurrent CDI (rCDI) has not improved. Elderly individuals (aged ≥ 65 years) are at higher risk of CDI, rCDI, and complicated CDI compared with younger individuals. OBJECTIVE:To analyze Medicare fee-forservice data for 12 months after an initial CDI episode, in order to obtain real-world data on health care resource utilization (HRU) and costs for elderly patients with CDI and rCDI. METHODS:A retrospective cohort study of patients who were aged ≥ 65 years and had a first (index) CDI diagnosis from January 1, 2010, to December 31, 2016, and continuous enrollment in Medicare Parts A, B, and D during the 12-month pre-index and 12-month post-index periods was conducted. A CDI episode was identified by either an inpatient stay with CDI diagnosis code or an outpatient medical claim with a CDI diagnosis code plus a CDI treatment. Each CDI episode was followed by a 14-day CDI claim-free period after the last CDI claim or end of CDI treatment. rCDI was a second or subsequent episode of CDI that occurred within an 8-week window after the 14-day CDI claim-free period. The number of CDI and rCDI episodes, HRU, time to recurrence, and total all-cause direct medical costs were calculated over the 12-month pre-index (baseline) and 12-month follow-up periods and stratified by number of rCDI episodes (No rCDI, 1 rCDI, 2 rCDI, 3+ rCDI). RESULTS:A total of 268,762 patients with an index CDI were included. Mean age was 78.3 years, and 69.0% were female. HRU was higher during the 6 months immediately pre-index versus 7-12 months pre-index, including a higher proportion of patients with a hospital admission (55.1% vs. 27.5%) or emergency department visit (41.3% vs. 27.4%), respectively. Moreover, 34.7% of the study population experienced rCDI. Of those What is already known about this subjectaffects more than 350,000 individuals in the United States annually and confers substantial physical, social, and emotional burden to the patient.• The burden of recurrent CDI (rCDI) has not improved, despite a nationally decreasing trend of all CDI cases in recent years.• Elderly individuals are at higher risk than younger individuals for CDI, rCDI, and complicated CDI.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Nelson

Scott

Boules

et al. 2021

JMCP

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“…It is estimated that all-cause direct medical costs for a population aged 18–64 were approximately US$72,000 for those with no recurrence and approximately US$200,000 for those with three or more recurrences. 3 Given these considerations, optimizing therapies with data-driven recommendations by experts in the field can be most beneficial to minimize the burden of this disease on our patients, lessen the frequency of recurrence, and improve overall outcomes. Clinical guideline recommendations are an essential tool guiding treatment as they summarize data for a disease and provide algorithms to manage patients based on data that has been critically validated.…”

Section: Introductionmentioning

confidence: 99%

Evolution of clinical guidelines for antimicrobial management of Clostridioides difficile infection

Chaar

Feuerstadt

2021

Therap Adv Gastroenterol

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Clostridioides difficile infection (CDI) has been an epidemic for many years. Our biggest challenge in treating CDI is preventing recurrence, which is seen in approximately 25% of patients with initial infection and in 40–60% of those with subsequent episodes. Given the major disease burden of this infection, appropriate data-driven treatment remains essential. Clinical treatment guidelines provide an unbiased critical analysis of the literature, integrating the quality of the available data to make recommendations. As CDI has been evolving and more research has become available, the frequency of guideline issue from various global societies has increased, as has the detail of the recommendations to fit more relevant clinical scenarios. In this review, we will discuss clinical guideline recommendations over three time periods: The Initial Guidelines 1995–1997, The Second Wave 2009–2013, and The Modern Era 2014–present. We see the changing recommendations from metronidazole or vancomycin for initial infection during earlier times to preferential treatment with fidaxomicin within the Infectious Diseases Society of America (IDSA) and Society of Healthcare Epidemiology of America (SHEA) joint guidelines provisional update in late 2020. The recommended treatments for first recurrence were initially with the same antimicrobial as the first episode but have since changed to having multiple options for one or more recurrences. We have also seen the addition of immune boosting treatments, including fecal microbiota transplantation (FMT)/microbiota restoration therapy (MRT) and bezlotoxumab in the more modern recommendations. As the guidelines are evolving with the times, it remains important to understand the differences among them so we can apply this information clinically and optimize patient outcomes.

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“…Additionally, there are tremendous health care economics and social implications of C difficile infection, with costs of more than 5 billion dollars a year in the United States. 6,7 Patients with C difficile infection unfortunately develop several psychosocial complications including anxiety of illness and a decreased quality of life. 8 Although it has been known for more than 4 decades that this bacterium causes human diarrhea, there remain several challenges to make an accurate diagnosis and optimal management of C difficile infection.…”

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confidence: 99%

My Treatment Approach to Clostridioides difficile Infection

Khanna

2021

Mayo Clinic Proceedings

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Clostridioides difficile infection is the most common cause of infectious diarrhea in hospitals with an increasing incidence in the community. Clinical presentation of C difficile infection ranges from diarrhea manageable in the outpatient setting to fulminant infection requiring intensive care admission. There have been significant advances in the management of primary and recurrent C difficile infection including diagnostics, newer antibiotics, antibody treatments, and microbiome restoration therapies. Because of the risk of clinical false-positive results with the polymerase chain reaction test, a two-step assay combining an enzyme immune assay for glutamate dehydrogenase and the C difficile toxin is being used. Cost permitting, I treat a first episode of C difficile infection preferably with fidaxomicin over vancomycin but not metronidazole. The most common complication after C difficile infection is recurrence. I manage a first recurrence with a vancomycin taper and pulse or fidaxomicin and recommend a single dose of intravenous bezlotoxumab (a monoclonal antibody against the toxin B) to reduce recurrence rates for those patients at high risk. Patients with multiply recurrent C difficile infection are managed with a course of antibiotics such as vancomycin or fidaxomicin followed by microbiota restoration. The success of fecal microbiota transplantation is greater than 85%, compared with the 40% to 50% success rate of antibiotics in this situation. Fecal microbiota transplantation is heterogeneous and has rare but serious risks such as transmission of infections. Standardized microbiota restoration therapies are in clinical development and have completed phase III clinical trials. This review answers common clinical questions in the management of C difficile infection.

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Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis

Cited by 50 publications

References 28 publications

Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Evolution of clinical guidelines for antimicrobial management of Clostridioides difficile infection

My Treatment Approach to Clostridioides difficile Infection

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