Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-24T00:57:48.425Z Has data issue: false hasContentIssue false
  • English
  • Français

Attributable Cost of Clostridium difficile Infection in Pediatric Patients

Published online by Cambridge University Press:  27 November 2017

Preeti Mehrotra ,
Jisun Jang ,
Courtney Gidengil  and
Thomas J. Sandora
Preeti Mehrotra*
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts
Jisun Jang
Affiliation:
Clinical Research Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Courtney Gidengil
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts RAND Corporation, Boston, Massachusetts
Thomas J. Sandora
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston Massachusetts
*
Address correspondence to Preeti Mehrotra, MD, Division of Infectious Diseases, Boston Children’s Hospital, 320 Longwood Avenue, Boston, MA 02115 (pmehrotr@bidmc.harvard.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVES

The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children.

DESIGN AND METHODS

We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score–matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost.

RESULTS

We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days.

CONCLUSIONS

Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost.

Infect Control Hosp Epidemiol 2017;38:1472–1477

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1472 - 1477
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. This work was previously presented at the Society for Healthcare Epidemiology of America: Science Guiding Prevention 2015 conference in Orlando, Florida, on May 15, 2015.

References

REFERENCES

1. Gould, CV, McDonald, LC. Bench-to-bedside review: Clostridium difficile colitis. Crit Care 2008;12:203.Google Scholar
2. Antibiotic Resistance Threats. 2013. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/threat-report-2013/index.html. Published 2013. Accessed November 2, 2017.Google Scholar
3. Dubberke, ER, Reske, K, Olsen, M, McDonald, LC, Fraser, VJ. Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497–504.Google Scholar
4. Crews, JD. Clostridium difficile diarrhea in children: diagnosis, management, and prevention. e-Medscape 2014:1–7.Google Scholar
5. Dubberke, ER, Butler, AM, Reske, K., et al. Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis 2008;14:1031–1038.Google Scholar
6. Nanwa, N, Kendzerska, T, Krahn, M, et al. The economic impact of Clostridium difficile infection: a systematic review. Am J Gastroenterol 2015;110:511–519.Google Scholar
7. White House Office of Management and Budget. United States Fiscal Year Budget, 2016. Government Publishing Office website. https://www.gpo.gov/fdsys/pkg/BUDGET-2016-BUD/pdf/BUDGET-2016-BUD.pdf. Published 2016. Accessed November 2, 2017.Google Scholar
8. Dubberke, ER, Carling, P, Carrico, R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:628–645.Google Scholar
9. Benson, L, Song, X, Campos, J, Singh, N. Changing epidemiology of Clostridium difficile-associated disease in children. Infect Control Hosp Epidemiol 2007;28:1233–1235.Google Scholar
10. Kim, J, Smathers, SA, Prasad, P, Leckerman, KH, Coffin, S, Zaoutis, T. Epidemiological features of Clostridium difficile-associated disease among inpatients at children’s hospitals in the United States, 2001–2006. Pediatrics 2008;122:1266–1270.Google Scholar
11. Zilberberg, MD, Tillotson, GS, McDonald, C. Clostridium difficile infections among hospitalized children, United States, 1997–2006. Emerg Infect Dis 2010;16:604–609.Google Scholar
12. Kyne, L, Hamel, MB, Polavaram, R, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile . Clin Infect Dis 2002;34:346–353.Google Scholar
13. O’Brien, J a, Lahue, BJ, Caro, JJ, Davidson, DM. The emerging infectious hallenge of Clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences. Infect Control Hosp Epidemiol 2007;28:1219–1227.Google Scholar
14. Dubberke, ER, Olsen, M. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis 2012;55:88–92.Google Scholar
15. Tabak, YP, Zilberberg, MD, Johannes, RS, Sun, X, McDonald, LC. Attributable burden of hospital-onset Clostridium difficile infection: a propensity score matching study. Infect Control Hosp Epidemiol 2013;34:588–596.Google Scholar
16. Sammons, JS, Localio, R, Xiao, R, Coffin, SE, Zaoutis, T. Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clin Infect Dis 2013;57:1–8.Google Scholar
17. Agency for Healthcare Research and Quality. Kids’ inpatient database 2012: introduction. Healthcare Cost and Utlization Project (HCUP) website. https://www.hcup-us.ahrq.gov/db/nation/kid/KID_2012_Introduction.pdf. Published 2014. Accessed November 2, 2017.Google Scholar
18. Dubberke, ER, Reske, K, McDonald, LC, Fraser, VJ. ICD-9 codes and surveillance for Clostridium difficile-associated disease. Emerg Infect Dis 2006;12:1576–1579.Google Scholar
19. Shaklee, J, Zerr, DM, Elward, A, et al. Improving surveillance for pediatric Clostridium difficile infection: derivation and validation of an accurate case-finding tool. Pediatr Infect Dis J 2011;30:e38–e40.Google Scholar
20. Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project. Kids’ inpatient database cost-to-charge ratio files. https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed November 2, 2017.Google Scholar
21. Sandora, TJ, Fung, M, Flaherty, K, et al. Epidemiology and risk factors for Clostridium difficile infection in children. Pediatr Infect Dis J 2011;30:580–584.Google Scholar
22. Sammons, JS, Toltzis, P, Zaoutis, TE. Clostridium difficile infection in children. JAMA Pediatr 2013;167:567–573.Google Scholar
23. Owens, RC, Donskey, CJ, Gaynes, RP, Loo, VG, Muto, C. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46:19–31.Google Scholar
24. Dugoff, EH, Schuler, M, Stuart, EA. Generalizing observational study results: applying propensity score methods to complex surveys. Health Serv Res 2014;49:284–303.Google Scholar
25. Zanutto, EL. A comparison of propensity score and linear regression analysis of complex survey data. J Data Sci 2006;4:67–91.Google Scholar
26. Korn, EL, Graubard, BI. Epidemiologic studies utilizing surveys: accounting for the sampling design. Am J Public Health 1991;81:1166–1173.Google Scholar
27. Pfeffermann, D. The role of sampling weights when modeling survey data. Int Stat Rev 1993;61:317–337.Google Scholar
28. Goudie, A, Dynan, L, Brady, PW, Rettiganti, M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics 2014;133:1525–1532.CrossRefGoogle ScholarPubMed
29. Asensio, A, Di Bella, S, Lo Vecchio, A, et al. The impact of Clostridium difficile infection on resource use and costs in hospitals in Spain and Italy: a matched cohort study. Int J Infect Dis 2015;36:31–38.Google Scholar
30. Nylund, CM, Goudie, A, Garza, JM, Fairbrother, G, Cohen, MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011;165:451–457.Google Scholar
31. Jimenez, J, Drees, M, Loveridge-Lenza, B, Eppes, S, delRosario, F. Exposure to gastric acid-suppression therapy is associated with healthcare-associated and community-associated C. difficile infection in children. J Pediatr Gastroenterol Nutr 2015;61:208–211.Google Scholar
32. Dubberke, ER, Butler, AM, Yokoe, DS, et al. Multicenter study of surveillance for hospital-onset Clostridium difficile infection by the use of ICD-9-CM diagnosis codes. Infect Control Hosp Epidemiol 2010;31:262–268.Google Scholar
33. Gupta, A, Khanna, S. Community-acquired Clostridium difficile infection: an increasing public health threat. Infect Drug Resist 2014;7:63–72.Google Scholar
34. Slayton, RB, Scott, RD, Baggs, J, Lessa, FC, McDonald, LC, Jernigan, JA. The cost-benefit of federal investment in preventing Clostridium difficile infections through the use of a multifaceted infection control and antimicrobial stewardship program. Infect Control Hosp Epidemiol 2015;36:681–687.Google Scholar