Original Research

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

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

Author(s):

References

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From HealthCore, Wilmington, DE, and Cubist Pharma-ceuticals, San Diego, CA.

Abstract

Objectives: To describe trends in inpatient resource utilization and potential cost drivers of Clostridium difficile -associated diarrhea (CDAD) treated in the hospital.
Methods: Retrospective medical record review included 500 patients with ≥1 inpatient medical claim diagnosis of CDAD (ICD-9-CM: 008.45) between 01/01/2005-10/31/2010. Information was collected on patient demographics, admission diagnoses, laboratory data, and CDAD-related characteristics and discharge. Hospital costs were evaluated for the entire inpatient episode and prorated for the duration of the CDAD episode (ie, CDAD diagnosis date to diarrhea resolution/discharge date).
Results: The cohort was mostly female (62%), Caucasian (72%), with mean (SD) age 66 (±17.6) years. 60% had diagnosis of CDAD or presence of diarrhea at admission. CDAD diagnosis was confirmed with laboratory test in 92% of patients. ~44% had mild CDAD, 35% had severe CDAD. Following CDAD diagnosis, approximately 53% of patients were isolated for ≥1 days, 12% transferred to the ICU for a median (Q1–Q3) length of stay of 8 (5–15) days. Two-thirds received gastrointestinal or infectious disease consult. Median time from CDAD diagnosis to discharge was 6 (4–9) days; 5.5 (4–8) days for patients admitted with CDAD, 6.5 (4–10) days for those with hospital-acquired CDAD. The mean and median costs (2011 USD) for CDAD-associated hospitalization were $35,621 and $13,153, respectively.
Conclusion: Patients with CDAD utilize numerous expensive resources during hospitalization including laboratory tests, isolation, prolonged ICU stay, and specialist consultations.

Clostridium difficile , classified as an urgent public health threat by the Centers for Disease Control and Prevention (CDC), causes approximately 250,000 hospitalizations and an estimated 14,000 deaths per year in the United States [1]. An estimated 15% to 25% of patients with C. difficile -associated diarrhea (CDAD) will experience at least 1 recurrence [2-4], frequently requiring rehospitalization [5]. The high incidence of primary and recurrent infections contributes to a substantial burden associated with CDAD in terms of extended and repeat hospital stays [6,7].

Conservative estimates of the direct annual costs of CDAD in the United States over the past 15 years range from $1.1 billion [8] to $3.2 billion, with an average cost per stay of $10,212 for patients hospitalized with a principal diagnosis of CDAD or a CDAD-related symptom [5]. O’Brien et al estimated that costs associated with rehospitalizations accounted for 11% of overall CDAD-related hospital costs;when considering all CDAD-related hospitalizations, including both initial and subsequent rehospitalizations for recurrent infection and not accounting for post-acute or outpatient care, the 2-year cumulative cost was estimated to be $51.2 million. While studies have yielded varying assessments of the actual CDAD burden [5–10], they all suggest that CDAD burden is considerable and that extended hospital stays are the major component of CDAD-associated costs [9,10]. In a claims-based study by Quimbo et al [11], when multiple and diverse cohorts of CDAD patients at elevated risk for recurrence were matched with patients with similar underlying at-risk condition(s) but no CDAD, the CDAD at-risk groups had an incremental LOS per hospitalization ranging from approximately 3 to 18 days and an incremental cost burden ranging from a mean of $11,179 to $115,632 (2011 USD) per stay.