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Systematic review confirms economic burden of C. difficile infection
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The economic burden of Clostridium difficile infection was confirmed in a systematic review published in The American Journal of Gastroenterology.
However, researchers recommend that further research following a standard cost methodology be conducted to better understand the economic impact of C. difficile.
“With [C. difficile infection] increasing in frequency and severity, it is important to estimate the economic burden,” Natasha Nanwa, MSc, from the Leslie Dan Faculty of Pharmacy, University of Toronto, and colleagues wrote. “Decision-makers can use cost-of-illness studies to aid in strategic planning, and researchers can incorporate [cost-of-illness] estimates in economic evaluations that, in turn, inform health policy.”
Forty-five studies that calculated the direct costs of C. difficile infection prevention and management were pulled from various databases and gray literature. The studies were conducted in the United States (84%), Canada, Australia, Germany, Ireland, Japan and the United Kingdom between 1988 and 2014. More than half were conducted between 2011 and 2013.
According to the data, costs directly related to C. difficile infection were generally determined by the length of hospitalization (87%) and ranged from $8,911 to $30,049. Hospital stays were the largest cost driver compared with laboratory investigations and drug therapies.
Several studies observed the cost–effect of C. difficile infection in various patient-populations, including patients admitted to intensive care, those undergoing surgery or transplants and patients with cancer, inflammatory bowel disease, cirrhosis and renal disease. Twenty-three studies showed that among those populations, patients with C. difficile infection had statistically significant higher costs compared with patients without C. difficile infection.
Heterogeneity among the studies refrained researchers from performing a meta-analysis. None of the studies specified an epidemiological approach or resource quantification methods and few provided a sensitivity analysis (7%) and patient perspective (16%). Researchers recommended that future cost-of-illness studies include this data and follow similar costing methods. In addition, patients with the least amount of data, such as those with recurrent C. difficile infection, community-acquired C. difficile infection and children, need further evaluation.
“These recommendations will provide high-quality cost evidence to aid decisions on [C. difficile infection] treatment (eg, new antibiotics, fecal microbiota transplantation) and prevention (eg, cleaning devices, antibiotic stewardship programs) strategies,” Nanwa and colleagues wrote. – by Stephanie Viguers
Disclosure: Nanwa reports receiving graduate salary from Pfizer Canada. No other researchers report relevant financial disclosures.
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