ReviewEconomic healthcare costs of Clostridium difficile infection: a systematic review
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.
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Data sources and search strategy
A search of the literature for peer-reviewed studies published from 1 January 1980 to 15 April 2009 was performed using Medline and PubMed. The study period was chosen since no studies prior to 1980 were identified that assessed costs attributable to CDI. The search terms included ‘Clostridium difficile associated disease’, ‘Clostridium difficile infection’, ‘Clostridium difficile’, ‘cost’, ‘economic burden’, ‘nosocomial diarrhea’, ‘attributable cost’, and ‘economic outcomes’. Additional
Study characteristics
The literature search identified 466 English-language references of which 13 studies met final inclusion/exclusion criteria (Figure 1).4, 5, 6, 7, 11, 12, 13, 14, 15, 16, 17, 18, 19 A summary of study characteristics for the identified articles is shown in Table I. The study duration range was 4–60 months. Of the 13 studies identified for the review, 10 were from the USA and there was one each from Canada, UK and Ireland. The studies used different frameworks to evaluate costs. Studies
Discussion
The identified studies in this review estimated economic costs of CDI in four countries over a time period of 13 years (1995–2008). A reliable comparison of the different cost studies of CDI is difficult due to the substantial methodological differences, patient selection criteria, and methods of calculating costs; nevertheless a comparison of cost trends was possible. All the studies included in this review found CDI to be a significant economic healthcare burden in their respective settings,
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