Economic healthcare costs of Clostridium difficile infection: a systematic review

Summary

Clostridium difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients. CDI increases patient healthcare costs due to extended hospitalisation, re-hospitalisation, laboratory tests and medications. However, the economic costs of CDI on healthcare systems remain uncertain. The purpose of this study was to perform a systematic review to summarise available studies aimed at defining the economic healthcare costs of CDI. We conducted a literature search for peer-reviewed studies that investigated costs associated with CDI (1980 to present). Thirteen studies met inclusion and exclusion criteria. CDI costs in 2008 US dollars were calculated using the consumer price index. The total and incremental costs for primary and recurrent CDI were estimated. Of the 13, 10 were from the USA and one each from Canada, UK, and Ireland. In US-based studies incremental cost estimates ranged from $2,871 to $4,846 per case for primary CDI and from $13,655 to $18,067 per case for recurrent CDI. US-based studies in special populations (subjects with irritable bowel disease, surgical inpatients, and patients treated in the intensive care unit) showed an incremental cost range from $6,242 to $90,664. Non-US-based studies showed an estimated incremental cost of $5,243 to $8,570 per case for primary CDI and $13,655 per case for recurrent CDI. Economic healthcare costs of CDI were high for primary and recurrent cases. The high cost associated with CDI justifies the use of additional resources for CDI prevention and control.

Introduction

Clostridium difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients.¹ According to the Centers for Disease Control and Prevention (CDC), the annual incidence of CDI in the USA exceeds 250 000 hospitalised cases with a mortality rate of 1–2.5%.² The disease can range from mild diarrhoea to life-threatening colitis. The incidence and mortality of CDI is increasing, associated with an epidemic, hypervirulent strain of C. difficile (B1/NAP1) that has been reported in the USA and other countries.³

In addition to significant morbidity and the mortality, CDI increases healthcare costs due to extended hospitalisations and re-hospitalisations.4, 5 Studies have estimated an annual CDI economic cost for the USA between $750 million and $3.2 billion.4, 6, 7 An excellent review article by Dubberke et al. demonstrated significant costs associated with CDI.⁸ However, a systematic review of study quality, CDI costs in special populations, and changing costs over time were not performed. The objective of this study was to perform a systematic review of published studies that have assessed economic outcomes in patients with CDI to answer these questions.