Burden of Clostridium (Clostridioides) difficile infection during inpatient stays in the USA between 2012 and 2016

Summary

Background

The healthcare burden of Clostridium (Clostridioides) difficile infection (CDI) is high but not fully characterized.

Aim

To assess hospitalization costs, length of hospital stay (LOS) and in-hospital mortality attributable to CDI in the USA by analysing nationwide hospital discharge records over the 2012–2016 period.

Methods

A retrospective, observational study based on the Truven Health MarketScan Hospital Drug Database was conducted, in which 46,097 inpatient stays with a diagnosis of CDI were analysed. Costs, LOS and in-hospital mortality were studied for patients with either a principal or secondary (comorbidity) diagnosis of CDI, and for patients re-admitted because of CDI. If CDI was a comorbidity, its attributable burden was estimated by coarsened exact matching, comparing 17,273 CDI stays with 84,164 stays in a control group without a CDI diagnosis.

Findings

Inpatients for whom CDI was the main reason for hospitalization incurred mean costs of US$10,528 and an average LOS of 5.9 days. For CDI as a comorbidity, the mean additional cost was US$11,938 and the additional LOS was 4.4 days. CDI also increased the in-hospital mortality rate by 4.1%, on average.

Conclusion

This study is consistent with previous publications which demonstrated the high economic burden of CDI for healthcare settings and health insurance systems. When recorded as a comorbidity, CDI significantly increased hospital costs and LOS. These results highlight the need for innovative therapeutic approaches in the prevention and treatment of CDI.

Introduction

Clostridium (Clostridioides) difficile is an opportunistic, anaerobic, Gram-positive, spore-forming, toxin-producing bacterium of the intestinal microbiota. It can provoke potentially lethal C. difficile infection (CDI), with symptoms ranging from mild diarrhoea to pseudomembranous colitis [1]. C. difficile is acquired by ingesting spores transmitted from other patients or healthcare personnel, either through the hands or the environment [2], [3]. CDI is responsible for 15–25% of nosocomial cases of antibiotic-associated diarrhoea [4], [5]. It is the most commonly reported pathogen, responsible for 12.1% of healthcare-associated infections in the USA [6].

Since the 2000s, an increase in the incidence of CDI, associated with poorer patient outcomes, has been observed. This increase is linked to the spread of a particular C. difficile strain (BI/NAP1/027), which is more virulent and notably resistant to fluoroquinolones [7], [8], [9], [10]. From 2011 to 2015, the adjusted annual incidence rate of community-acquired CDI nearly doubled, while the incidence of healthcare-associated CDI increased from 0.62 to 0.88 cases per 1000 patient-days [11].

Risk factors for C. difficile include the use of antibiotics (especially broad-spectrum antibiotics that profoundly disrupt the gut microbiota), the severity of underlying diseases, advanced age, and length of hospital stay (LOS) [12].

In a recent study modelling the cost of CDI in the USA, the economic burden of CDI was estimated to reach US$5.4 billion in 2014, including US$4.7 billion (86.7%) in healthcare settings and US$725 million (13.3%) in the community [13]. Given this high economic impact, there is a need to assess, in detail, the outcomes for patients with CDI, with a specific focus on mortality, LOS and costs borne by healthcare systems.

The objective of this study was to assess, from a third-party payer perspective, hospitalization costs, LOS and in-hospital mortality attributable to CDI in the USA by analysing nationwide hospital discharge records over the 2012–2016 period.