Original Research

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

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

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Limitations

One major limitation of this study was the inability to assess the individual costs of the resources used for each individual patient either through the medical charts or via claims. Additionally, the burden of CDAD was found to continue beyond the hospital stay, with documented evidence of persisting infection in 84% of patients at the point of discharge. Since the medical records obtained were limited to a single hospitalization and a single place of service, the data capture of an entire CDAD episode remains potentially incomplete for a number of patients who had recurrences or who had visited multiple sites of care in addition to the hospital (ie, emergency department or outpatient facility). The transition to outpatient care is often multifaceted and challenging for patients, especially those who are elderly and have multiple underlying conditions [18]. Access to care become more difficult, and patients become wholly responsible for taking their medication as prescribed and following other post-discharge treatment stratagems. Furthermore, no differentiation was made between patients having a primary versus secondary CDAD diagnosis.

Another limitation is that the costs of the hospitalization was calculated from claims and as such do not include either patient paid costs (eg, deductible) or indirect costs (eg, lost work or productivity or caregiver costs) due to CDAD. This study likely underestimates the true costs associated with CDAD. Finally, the patients included in this analysis were all members of large commercial health plans in the US and who are also working and relatively healthy. Therefore, these results may not be generalizable to patients with other types of health insurance or no insurance or to those living outside of the United States.

It is important to note that the trends and drivers described in this study are “potential” influencers contributing to the burden of CDAD. Given that this study is descriptive in nature, formal analyses aimed at confirming these factors as “drivers” should be conducted in future. CDAD-related hospitalizations have previously been shown to be associated with increased inpatient LOS and a substantial economic burden. Our study demonstrates that the CDAD-associated cost burden in hospital settings may be driven by the use of numerous high-cost hospital resources including prolonged ICU stays, isolation, frequent GI and ID consultations, CDAD-related non-diagnostic tests/procedures, and symptomatic CDAD treatment.

Acknowledgments: The authors acknowledge Cheryl Jones for her editorial assistance in preparing this manuscript.

Corresponding author: Swetha Rao Palli, CTI Clinical Trial and Consulting, 1775 Lexington Ave, Ste. 200, Cincinnati, OH 45209, swetharao.palli@gmail.com

Funding/support: Funding for this study was provided Cubist Pharmaceuticals.

Financial disclosures: Ms. Palli and Mr. Quimbo are former and current employees of HealthCore, respectively. HealthCore is an independent research organization that received funding from Cubist Pharmaceuticals for the conduct of this study. Dr. Broderick is an employee of Cubist Pharmaceuticals. Ms. Strauss was an employee of Optimer Pharmaceuticals during the time the study was carried out.