Hospitalized Patients with Cirrhosis Should Be Screened for Clostridium difficile Colitis

Abstract

Background: Clostridium difficile infection (CDI) is an important public health problem in hospitalized patients. Patients with cirrhosis are particularly at risk of increased associated morbidity, mortality, and healthcare utilization from CDI.

Aim: The aim of this study was to assess the pharmacoeconomic impact of CDI screening on hospitalized patients with cirrhosis.

Methods: A Markov model was used to compare costs and outcomes of two strategies for the screening of CDI. The first strategy consisted of screening all patients for CDI and treating if detected (screening). In the second strategy, only patients found to have symptomatic CDI were treated (no screening). The probability of underlying CDI prevalence, symptomatic CDI infection, and likelihood of recurrent infection were varied in a sensitivity analysis. The costs of antibiotics and hospitalization were also assessed. Differences in outcome were expressed in ratio of the total costs associated with screening to the total costs associated without screening.

Results: The results of our model showed that screening for CDI was consistently associated with improved healthcare outcomes and decreased healthcare utilization across all variables in the one- and two-way sensitivity analyses. Using baseline assumptions, the costs associated with the no screening strategy were 3.54 times that of the screening strategy. Moreover, the mortality for symptomatic CDI was lower in the screening strategy than the no screening strategy.

Conclusion: The screening strategy results in less healthcare utilization and improved clinical outcomes. Screening for CDI measures favorably.

Keywords: Asymptomatic carriers; C. Difficile screening; Cost-effectiveness; Hospitalized patients.