Published in:
01-12-2015 | Original Paper
Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital
Published in: Infection | Issue 6/2015
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Purpose
Clostridium difficile associated diarrhoea (CDAD) is the most common cause of health-care-associated infectious diarrhoea. In the context of the German health-care system, direct and indirect costs of an initial episode of CDAD and of CDAD recurrence are currently unknown.
Methods
We defined CDAD as presence of diarrhoea (≥3 unformed stools/day) in association with detection of Clostridium difficile toxin in an unformed faecal sample. Patients treated with metronidazole (PO or IV) and/or vancomycin (PO) were included. Comprehensive data of patients were retrospectively documented into a database using the technology of the Cologne Cohort of Neutropenic Patients (CoCoNut). Patients with CDAD were matched to control patients in a 1:1 ratio. Analysis was split in three groups: incidence group (CDAD patients without recurrence), recurrence group (CDAD patients with ≥1 recurrence) and control group (matched non-CDAD patients).
Results
Between 02/2010 and 12/2011, 150 patients with CDAD (114 patients in the incidence and 36 (24 %) in the recurrence group) and 150 controls were analysed. Mean length of stay was: 32 (95 %CI: 30–37), 94 (95 %CI: 76–112) and 24 days (95 %CI: 22–27; P = <0.001), resulting in mean overall direct treatment costs per patient of €18,460 (95 %CI: €14,660–€22,270), €73,900 (95 %CI: €50,340–€97,460) and €14,530 (95 %CI: €11,730–€17,330; P = <0.001). In the incidence and recurrence group, the mean cumulative number of antibiotic CDAD treatment days was 11 (95 %CI: 10–12) and 36 (95 %CI: 27–45; P = <0.001).
Conclusions
Especially CDAD recurrence was associated with excessive costs, which were mostly attributable to a significantly longer overall length of stay. Innovative treatment strategies are warranted to reduce treatment costs and prevent recurrence of CDAD.