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CDI nearly doubles mortality, costs among seniors
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SAN DIEGO — Clostridium difficile-associated disease almost doubled mortality and total health care costs among patients aged 65 years and older in the United States, researchers reported at ICAAC 2015.
“The burden of C. diff is greatly underappreciated, because people either look at it from the perspective of the inpatient setting or the outpatient setting, and no one has taken a real global perspective of what this does to the patient, what it does to the health care system, and more importantly … the downstream consequences in terms of a cost-differential and also a morbidity and mortality penalty to our patients that persists beyond 2 months after the event, and perhaps even accelerates after a year,” Andrew F. Shorr, MD, MPH, director of the medical ICU and interim director of pulmonary and critical care at MedStar Washington Hospital Center, told Infectious Disease News.
Shorr and colleagues conducted a large, retrospective, population-based cohort study of U.S. adults enrolled in Medicare between 2008 and 2010. They compared differences in mortality and health care costs of patients with and without incident C. difficile over the course of a year. Approximately 1.6 million patients were included in the analysis.
Andrew F. Shorr
Of the entire cohort, 0.6% experienced C. difficile-associated disease in 2009. According to the researchers, most patients (82.5%) acquired their infection in the hospital. Those with C. difficile tended to be older than those without the disease (mean age, 81 years vs. 77 years; P < .001) and were more likely to reside in the Northeast (P < .001). Patients infected with C. difficile also experienced a greater burden of comorbidities (P < .001). In addition, prior hospitalizations (63.2% vs. 6%; P < .001) and antibiotic use (33.9% vs. 12.5%; P < .001) within the past 90 days were more common in those with C. difficile.
One-quarter of patients with C. difficile died within a year of their diagnosis, Shorr said. In propensity-adjusted analysis, patients with C. difficile-associated disease faced almost twice the mortality (42.6% vs. 23.4%; P < .001) as seniors without the infection. The difference in mortality was apparent early on, according to Shorr, and only appeared to accelerate over the course of a year among those with C. difficile.
“This is what the disease does to you,” he said during a presentation.
Total health care costs also were twice as high among seniors with C. difficile ($64,807 ± $66,480 vs. $38,128 ± $46,485; P < .001) — a difference of more than $26,000. Shorr noted that these figures represent actual health care costs covered by Medicare, an accurate assessment of the financial impact of the disease.
“We estimate that this translates into about 46,000 potential deaths, over $6 billion in health care costs and 240,000 Medicare patients with C. diff,” Shorr said. “Perhaps the most powerful interventions we can have to address this disease state are going to focus on prevention.” – by John Schoen
Reference:
Zilberberg MD, et al. Clostridium difficile-associated Disease Nearly Doubles Mortality and Healthcare Costs in Medicare Population. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: Shorr reports being a consultant for Pfizer and a consultant and grant investigator for Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.