THE ECONOMIC IMPACT OF CLOSTRIDIUM DIFFICILE: A SYSTEMATIC REVIEW

Tuesday, October 21, 2014
Poster Board # PS3-34

Candidate for the Lee B. Lusted Student Prize Competition

Natasha Nanwa, MSc1, Tetyana Kendzerska, MD, MSc, PhD2, Murray D. Krahn, MD, MSc3, Jeffrey Kwong, MD, MSc4, Nick Daneman, MD, MSc2, William Witmann, MISt5, Nicole Mittmann, MSc, PhD6, Suzanne Cadarette, MSc, PhD1, Laura Rosella, MPH, PhD7 and Beate Sander, PhD8, (1)Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada, (2)Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada, (3)Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada, (4)Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, (5)Université Laval, Québec, QC, Canada, (6)Sunnybrook Health Sciences Centre, Toronto, ON, Canada, (7)Ontario Agency for Health Protection and Promotion, Toronto, ON, Canada, (8)University of Toronto, Toronto, ON, Canada
Purpose: The objective was to systematically review Clostridium difficile (CD) cost of illness (COI) studies.

Method: We conducted searches of 6 databases: 1) MEDLINE®; 2) Embase; 3) Health Technology Assessment Database; 4) National Health Service Economic Evaluation Database; 5) Cost-Effectiveness Analysis Registry; and 6) EconLit. We consulted a librarian to develop search terms relating to CD and costs. Two independent reviewers screened articles based on inclusion and exclusion criteria. One reviewer abstracted data and performed the quality appraisal using a modified version of a guideline for economic evaluations, consistent with other COI systematic reviews. A second reviewer validated the abstraction and appraisal. All cost results are presented in 2013 United States (US) dollars (converted to US currency using Purchasing Power Parity and/or inflated to 2013 using the Consumer Price Index).

Result: We identified 39 COI studies published between 1988 and 2013. Forty-nine percent were published in the last 3 years. The studies spanned 7 countries: US, Canada, Australia, Germany, Ireland, Japan, and United Kingdom. Most studies were from the US (82%), calculated costs over the duration of the hospital stay (85%), and focused on direct costs (100%). Four studies found CD to increase costs 1.3-2.0 times (data from US and Japan), whereas one study found no increase (US data). Mean attributable CD costs ranged from $4,039 to $27,582 per case/patient/admission/episode (6 studies, data from US, Australia, and Ireland). Mean cost of CD recurrence per patient (not attributable) ranged from $11,007 to $15,339 (2 studies, data from US and Canada). In studies that stratified cost results (3 studies, US data), CD costs were greater in those with a secondary diagnosis of CD compared to a principal diagnosis of CD and in those with a high Horn’s index (severity score) versus a low Horn’s index. Few studies stated an epidemiological approach or resource quantification methods (0%), conducted sensitivity analyses (3%), stated perspectives (15%), or stated the year and currency of costs (21%).

Conclusion: Thirty-nine COI studies quantified and most confirmed the economic burden associated with CD. Future studies should follow COI methodology more closely, and evaluate attributable and/or indirect costs (e.g., loss in productivity), cost of other healthcare resources (e.g., emergency room visits, homecare), complications (e.g., colectomy), initial versus recurrent infection, and/or community-acquired versus hospital-acquired infection.

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