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. 2023 Mar 4;76(5):809-815.
doi: 10.1093/cid/ciac841.

Costs Attributable to Clostridioides difficile Infection Based on the Setting of Onset

John M Sahrmann  1 , Margaret A Olsen  1   2 , Dustin Stwalley  1 , Holly Yu  3 , Erik R Dubberke  1
Affiliations

Costs Attributable to Clostridioides difficile Infection Based on the Setting of Onset

John M Sahrmann et al. Clin Infect Dis. .

Abstract

Background: Although hospital-onset Clostridioides difficile infection (CDI) is associated with significant healthcare costs, the economic burden of CDI with onset in other facilities or the community has not been well studied.

Methods: Incident CDI cases were identified using 2011-2017 Medicare fee-for-service data. Controls were randomly selected in a 4:1 ratio matching to the CDI case surveillance definition. Inverse probability of exposure weights were used to balance on measured confounders. One-, 3-, and 5-year cumulative costs attributable to CDI were computed using a 3-part estimator (parametric survival model and pair of 2-part models predicting costs separately in intervals where death did and did not occur).

Results: A total of 60 492 CDI cases were frequency-matched to 241 968 controls. One-, 3-, and 5-year adjusted attributable costs were highest for hospital-onset CDI at $14 257, $18 953, and $21 792, respectively, compared with hospitalized controls and lowest for community-associated CDI compared with community controls at $1013, $3161, and $6454, respectively. Adjusted 1-, 3-, and 5-year costs attributable to community-onset healthcare facility-associated CDI were $8222, $13 066, and $16 329 and for other healthcare facility-onset CDI were $5345, $6764, and $7125, respectively.

Conclusions: Economic costs attributable to CDI in elderly persons were highest for hospital-onset and community-onset healthcare facility-associated CDI. Although lower, attributable costs due to CDI were significantly higher in cases with CDI onset in the community or other healthcare facility than for comparable persons without CDI. Additional strategies to prevent CDI in the elderly are needed to reduce morbidity and healthcare expenditures.

Keywords: Clostridioides difficile infection; Medicare data; attributable costs; healthcare costs.

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Conflict of interest statement

Potential conflicts of interest. M. A. O. reports receipt of grant funding from Pfizer and personal fees from Pfizer for consulting work. E. R. D. reports receipt of grant funding from Pfizer, Synthetic Biologics, and Ferring and personal fees from Ferring, Rebiotix, Summit, Merck, Pfizer, and Seres. H. Y. is an employee of Pfizer, and has stock or stock options for Pfizer. D. S. reports stock or stock options from AbbVie, Inc, and Bristol-Myers Squibb. The remaining author reports no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Crude, unadjusted, and adjusted costs of Clostridioides difficile infection (CDI), expressed as the intensity effect, mortality effect, and attributable costs of CDI, by surveillance category. A, One-year costs. B, Three-year costs. C, Five-year costs. The crude estimates consist of the observed differences in mean costs between the cases and frequency-matched controls. The unadjusted estimates were derived using the Basu and Manning estimator with CDI as the only covariate in each of the models, while the adjusted estimates included the full set of covariates in the models. The effect estimates for each surveillance category are displayed as intensity, mortality, and attributable effects, where the intensity effect estimates the additional costs of CDI due to differences in healthcare utilization and the mortality effect estimates the difference in costs due to CDI because of differential mortality between cases with CDI and uninfected controls. The attributable costs represent the overall estimated incremental costs attributable to CDI. Abbreviations: CA, community associated; HCFA, community onset-health care facility associated; HO, hospital onset; OHFO, other healthcare facility onset.
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