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The Economic Burden of Hospital-Acquired Clostridium difficile Infection: A Population-Based Matched Cohort Study

Published online by Cambridge University Press:  20 June 2016

Natasha Nanwa ,
Jeffrey C. Kwong ,
Murray Krahn ,
Nick Daneman ,
Hong Lu ,
Peter C. Austin ,
Anand Govindarajan ,
Laura C. Rosella ,
Suzanne M. Cadarette  and
Beate Sander
Natasha Nanwa*
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada
Jeffrey C. Kwong
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Canada University Health Network, Toronto, Canada Department of Family and Community Medicine, University of Toronto, Toronto, Canada Public Health Ontario, Toronto, Canada
Murray Krahn
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada University Health Network, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
Nick Daneman
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Sunnybrook Health Sciences Centre, Toronto, Canada
Hong Lu
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada
Peter C. Austin
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada Sunnybrook Health Sciences Centre, Toronto, Canada
Anand Govindarajan
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada Mount Sinai Hospital, Toronto, Canada Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
Laura C. Rosella
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Public Health Ontario, Toronto, Canada
Suzanne M. Cadarette
Affiliation:
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada
Beate Sander
Affiliation:
Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Public Health Ontario, Toronto, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
*
Address correspondence to Natasha Nanwa, MSc, Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, 6th Fl, Rm 658, Toronto, Ontario, M5S 3M2, Canada (natasha.nanwa@mail.utoronto.ca).
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Abstract

BACKGROUND

High-quality cost estimates for hospital-acquired Clostridium difficile infection (CDI) are vital evidence for healthcare policy and decision-making.

OBJECTIVE

To evaluate the costs attributable to hospital-acquired CDI from the healthcare payer perspective.

METHODS

We conducted a population-based propensity-score matched cohort study of incident hospitalized subjects diagnosed with CDI (those with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada code A04.7) from January 1, 2003, through December 31, 2010, in Ontario, Canada. Infected subjects were matched to uninfected subjects (those without the code A04.7) on age, sex, comorbidities, geography, and other variables, and followed up through December 31, 2011. We stratified results by elective and nonelective admissions. The main study outcomes were up-to-3-year costs, which were evaluated in 2014 Canadian dollars.

RESULTS

We identified 28,308 infected subjects (mean annual incidence, 27.9 per 100,000 population, 3.3 per 1,000 admissions), with a mean age of 71.5 years (range, 0–107 years), 54.0% female, and 8.0% elective admissions. For elective admission subjects, cumulative mean attributable 1-, 2-, and 3-year costs adjusted for survival (undiscounted) were $32,151 (95% CI, $28,192–$36,005), $34,843 ($29,298–$40,027), and $37,171 ($30,364–$43,415), respectively. For nonelective admission subjects, the corresponding costs were $21,909 ($21,221–$22,609), $26,074 ($25,180–$27,014), and $29,944 ($28,873–$31,086), respectively.

CONCLUSIONS

Hospital-acquired CDI is associated with substantial healthcare costs. To the best of our knowledge, this study is the first CDI costing study to present longitudinal costs. New strategies may be warranted to mitigate this costly infectious disease.

Infect Control Hosp Epidemiol 2016;37:1068–1078

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 9 , September 2016 , pp. 1068 - 1078
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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