The Economic Impact of Clostridium difficile Infection: A Systematic Review

Nanwa, Natasha; Kendzerska, Tetyana; Krahn, Murray; Kwong, Jeffrey C.; Daneman, Nick; Witteman, William; Mittmann, Nicole; Cadarette, Suzanne M.; Rosella, Laura; Sander, Beate

doi:10.1038/ajg.2015.48

Cited by 84 publications

(75 citation statements)

References 69 publications

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“…We extracted the total number of CDI patients and CDI-attributable costs from previous studies [25] and reviews [17, 26] to carry out a sensitivity analysis of our total cost estimates.…”

Section: Methodsmentioning

confidence: 99%

Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study

et al. 2016

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BackgroundClostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea but the economic costs of CDI on healthcare systems in the US remain uncertain.MethodsWe conducted a systematic search for published studies investigating the direct medical cost associated with CDI hospital management in the past 10 years (2005–2015) and included 42 studies to the final data analysis to estimate the financial impact of CDI in the US. We also conducted a meta-analysis of all costs using Monte Carlo simulation.ResultsThe average cost for CDI case management and average CDI-attributable costs per case were $42,316 (90 % CI: $39,886, $44,765) and $21,448 (90 % CI: $21,152, $21,744) in 2015 US dollars. Hospital-onset CDI-attributable cost per case was $34,157 (90 % CI: $33,134, $35,180), which was 1.5 times the cost of community-onset CDI ($20,095 [90 % CI: $4991, $35,204]). The average and incremental length of stay (LOS) for CDI inpatient treatment were 11.1 (90 % CI: 8.7–13.6) and 9.7 (90 % CI: 9.6–9.8) days respectively. Total annual CDI-attributable cost in the US is estimated US$6.3 (Range: $1.9–$7.0) billion. Total annual CDI hospital management required nearly 2.4 million days of inpatient stay.ConclusionsThis review indicates that CDI places a significant financial burden on the US healthcare system. This review adds strong evidence to aid policy-making on adequate resource allocation to CDI prevention and treatment in the US. Future studies should focus on recurrent CDI, CDI in long-term care facilities and persons with comorbidities and indirect cost from a societal perspective. Health-economic studies for CDI preventive intervention are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1786-6) contains supplementary material, which is available to authorized users.

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“…We extracted the total number of CDI patients and CDI-attributable costs from previous studies [25] and reviews [17, 26] to carry out a sensitivity analysis of our total cost estimates.…”

Section: Methodsmentioning

confidence: 99%

Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study

et al. 2016

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“…A recent review regarding CDI cost-of-illness describes a mean cost ranging from 8911 to 30,049 USD for hospitalised patients (per patient/admission/episode/infection) in the USA [47]. In Europe, the annual economic burden is estimated to be approximately 3000 million euro [48].…”

Section: The Scope Of CDImentioning

confidence: 99%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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a b s t r a c tRecognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies. This review explores the history of C. difficile and the current scope of the infection. The variety of available laboratory tests for CDI diagnosis and strain typing methods are also examined.

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“…1 In the United States, treating CDI cases costs from $8,911 to $30,049 for primary infections, and $13,655 to $18,067 for recurrences. 10,11 To reduce CDI, infection prevention and control has been emphasized, such as through development and adherence to clinical practice guidelines (CPGs). 12 The CPGs aim to provide evidence-based recommendations to facilitate decision-making, improve patient care, and optimize resource use.…”

mentioning

confidence: 99%

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

Lytvyn

Mertz

Sadeghirad

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.

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The Economic Impact of Clostridium difficile Infection: A Systematic Review

Cited by 84 publications

References 69 publications

Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study

Cost of hospital management of Clostridium difficile infection in United States—a meta-analysis and modelling study

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

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