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. 2023 Jul;40(7):3104-3134.
doi: 10.1007/s12325-023-02498-x. Epub 2023 May 21.

Economic Impact of Recurrent Clostridioides difficile Infection in the USA: A Systematic Literature Review and Cost Synthesis

Kelly R Reveles  1 , Min Yang  2 , Viviana Garcia-Horton  3 , Marie Louise Edwards  3 , Amy Guo  4 , Thomas Lodise  5 , Markian Bochan  6 , Glenn Tillotson  7 , Erik R Dubberke  8
Affiliations

Economic Impact of Recurrent Clostridioides difficile Infection in the USA: A Systematic Literature Review and Cost Synthesis

Kelly R Reveles et al. Adv Ther. 2023 Jul.

Abstract

Introduction: Up to 35% of patients with a first episode of Clostridioides difficile infection (CDI) develop recurrent CDI (rCDI), and of those, up to 65% experience multiple recurrences. A systematic literature review (SLR) was conducted to review and summarize the economic impact of rCDI in the United States of America.

Methods: English-language publications reporting real-world healthcare resource utilization (HRU) and/or direct medical costs associated with rCDI in the USA were searched in MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Library databases over the past 10 years (2012-2022), as well as in selected scientific conferences that publish research on rCDI and its economic burden over the past 3 years (2019-2022). HRU and costs identified through the SLR were synthesized to estimate annual rCDI-attributable direct medical costs to inform the economic impact of rCDI from a US third-party payer's perspective.

Results: A total of 661 publications were retrieved, and 31 of them met all selection criteria. Substantial variability was found across these publications in terms of data source, patient population, sample size, definition of rCDI, follow-up period, outcomes reported, analytic approach, and methods to adjudicate rCDI-attributable costs. Only one study reported rCDI-attributable costs over 12 months. Synthesizing across the relevant publications using a component-based cost approach, the per-patient per-year rCDI-attributable direct medical cost was estimated to range from $67,837 to $82,268.

Conclusions: While real-world studies on economic impact of rCDI in the USA suggested a high-cost burden, inconsistency in methodologies and results reporting warranted a component-based cost synthesis approach to estimate the annual medical cost burden of rCDI. Utilizing available literature, we estimated the average annual rCDI-attributable medical costs to allow for consistent economic assessments of rCDI and identify the budget impact on US payers.

Keywords: Cost estimation; Healthcare resource utilization; Medical costs; Recurrent Clostridioides difficile infection; Systematic literature review.

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Conflict of interest statement

Min Yang, Viviana Garcia-Horton, and Marie Louise Edwards are employees of Analysis Group, Inc., which received funding from Ferring Pharmaceuticals, Inc., for conducting this research. Kelly R. Reveles, Amy Guo, Thomas Lodise, Markian Bochan, Glenn Tillotson, and Erik R. Dubberke have nothing to disclose.

Figures

Fig. 1
Fig. 1
PRISMA diagram. [1]The following hierarchy was applied to the exclusion criteria: (1) non-USA based, (2) study design, (3) population, (4) outcomes (e.g., if a study is both USA based and not the eligible study design, the reason for exclusion is “USA based”). PRISMA Preferred Reporting Items for Systematic Reviews and Meta-analyses, SLR systematic literature review
See this image and copyright information in PMC

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