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BMC Infect Dis. 2016 Aug 25;16(1):447. doi: 10.1186/s12879-016-1786-6.

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

Author information

1
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK. Shanshan.zhang@ed.ac.uk.
2
Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, 22 Zhongguancun South Avenue, Beijing, 100081, China. Shanshan.zhang@ed.ac.uk.
3
Sanofi Pasteur, Lyon, France.
4
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK.
5
Sanofi Pasteur, Swiftwater, PA, USA.
6
Lesli Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Clostridium 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.

METHODS:

We 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.

RESULTS:

The 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.

CONCLUSIONS:

This 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.

KEYWORDS:

Clostridium Difficile; Economic analysis; Meta-analysis; Systematic review

PMID:
27562241
PMCID:
PMC5000548
DOI:
10.1186/s12879-016-1786-6
[Indexed for MEDLINE]
Free PMC Article

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