Original Research

Cost Drivers Associated with Clostridium difficile-Associated Diarrhea in a Hospital Setting

Journal of Clinical Outcomes Management. 2015 March;22(3)

References

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Following CDAD diagnosis, more than half of the study patients were isolated for 1 or more days. While the majority of patients with CDAD (74.0%) stayed in a general hospital room, 12.4% stayed in the ICU for a mean duration of 12.1 (± 12.3) days ( Table 3 ). Half of these ICU patients required

isolation for at least 1 day. 5.6% stayed in the CCU in a private or semi-private room for 5 to 7 days during the CDAD episode.

About one-third of patients consulted a gastrointestinal or infectious disease specialist at least once. Among these patients, assuming that a patient following an initial specialist consultation would have follow-up visits at least once a day (formal or informal) for the remainder of the CDAD episode, we estimate that there were an average of 8.7 (± 15.6) and 11.6 (± 19.4) GI or ID specialist visits respectively during the CDAD episode.

Nearly all patients had their CDAD diagnosis confirmed by laboratory tests. CDAD virulence was identified as toxin A and/or toxin B in 47.6% of the samples. However, nearly three-fifths of patients also underwent 1 or more nondiagnostic tests including endoscopy, colonoscopy, computed axial tomography (CAT), or magnetic resonance imaging (MRI) scans, sigmoidoscopy, and/or other obstructive series tests during the CDAD episode.

CDAD Treatment

About 4.2% patients received no antibiotic treatment following CDAD diagnosis. Nevertheless, twice-daily metro-nidazole was the most frequently used antibiotic for CDAD (87.2%), with oral being the preferred route of administration among these patients. The median duration of treatment and daily dose were 4 (3–7) days and 1000 mg, respectively. Oral vancomycin was administered to nearly half of the patients for a median duration and daily dose of 5 (3–8) days and 500 mg, respectively; mean frequency of administration was 2.5 (± 1.2) times per day ( Table 4 ). One-third of the patients (33.6%) augmented their first-line therapy, most frequently adding vancomycin to the initial metronidazole treatment or vice-versa. Only 5.2% of patients switched completely from the first-line therapy, predominantly from metronidazole to vancomycin (4%).

CDAD at Discharge

Overall, the mean time from CDAD diagnosis to hospital discharge was 8.8 (± 13.3) days ( Table 5 ). Notably, CDAD was documented to persist in 84.4% of patients at the time of discharge, with 82.5% of patients obtaining prescriptions for post-discharge antibiotic treatment involving metronidazole, vancomycin, or rifaximin ( Table 6 ). Among the 7.6% of patients who died while hospitalized, CDAD was identified as the cause of death in one-fifth of these cases.

Hospitalization Costs

Based on claims data, the mean (±SD) and median (Q1–Q3) plan costs for the duration of a CDAD-associated hospitalization (2011 USD) for these 500 patients were found to be $35,621 (± $100,502) and $13,153 ($8,209–$26,893), respectively.

Discussion

While multiple studies have documented the considerable economic burden associated with CDAD [5–10], this study was the first to our knowledge to evaluate the specific hospital resources that are used during an extended hospital stay for CDAD. This real-world analysis, in conjunction with the Quimbo et al claims analysis, demonstrated the significant burden associated with CDAD in terms of both fixed costs (eg, hospital stay) as well as the variable components that drive these expenditures (eg, consultations, ICU stay).