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Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital

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Abstract

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.

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References

  1. Vehreschild MJ, Weitershagen D, Biehl LM, Tacke D, Waldschmidt D, Tox U, et al. Clostridium difficile infection in patients with acute myelogenous leukemia and in patients undergoing allogeneic stem cell transplantation: epidemiology and risk factor analysis. Biol Blood Marrow Transplant. 2014;. doi:10.1016/j.bbmt.2014.02.022.

    PubMed  Google Scholar 

  2. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011;377(9759):63–73. doi:10.1016/S0140-6736(10)61266-4.

    Article  PubMed  Google Scholar 

  3. Hensgens MP, Goorhuis A, Dekkers OM, van Benthem BH, Kuijper EJ. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clin Infect Dis. 2013;56(8):1108–16. doi:10.1093/cid/cis1209.

    Article  PubMed  Google Scholar 

  4. Gravel D, Miller M, Simor A, Taylor G, Gardam M, McGeer A, et al. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a canadian nosocomial infection surveillance program study. Clin Infect Dis. 2009;48(5):568–76. doi:10.1086/596703.

    Article  PubMed  Google Scholar 

  5. Labbe AC, Poirier L, Maccannell D, Louie T, Savoie M, Beliveau C, et al. Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain. Antimicrob Agents Chemother. 2008;52(9):3180–7. doi:10.1128/AAC.00146-08.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Pepin J, Valiquette L, Cossette B. Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005;173(9):1037–42. doi:10.1503/cmaj.050978.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Marwick CA, Yu N, Lockhart MC, McGuigan CC, Wiuff C, Davey PG, et al. Community-associated Clostridium difficile infection among older people in Tayside, Scotland, is associated with antibiotic exposure and care home residence: cohort study with nested case-control. J Antimicrob Chemother. 2013;68(12):2927–33. doi:10.1093/jac/dkt257.

    Article  CAS  PubMed  Google Scholar 

  8. Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014;69(4):881–91. doi:10.1093/jac/dkt477.

    Article  CAS  PubMed  Google Scholar 

  9. Kuijper EJ, Coignard B, Tull P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect. 2006;12(Suppl 6):2–18. doi:10.1111/j.1469-0691.2006.01580.x.

    Article  CAS  PubMed  Google Scholar 

  10. Kelly CP, LaMont JT. Clostridium difficile–more difficult than ever. N Engl J Med. 2008;359(18):1932–40. doi:10.1056/NEJMra0707500.

    Article  CAS  PubMed  Google Scholar 

  11. Sabau L, Meybeck A, Gois J, Devos P, Patoz P, Boussekey N, et al. Clostridium difficile colitis acquired in the intensive care unit: outcome and prognostic factors. Infection. 2014;42(1):23–30. doi:10.1007/s15010-013-0492-1.

    Article  CAS  PubMed  Google Scholar 

  12. Vardakas KZ, Polyzos KA, Patouni K, Rafailidis PI, Samonis G, Falagas ME. Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int J Antimicrob Agents. 2012;40(1):1–8. doi:10.1016/j.ijantimicag.2012.01.004.

    Article  CAS  PubMed  Google Scholar 

  13. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med. 2011;364(5):422–31. doi:10.1056/NEJMoa0910812.

    Article  CAS  PubMed  Google Scholar 

  14. Cornely OA, Crook DW, Esposito R, Poirier A, Somero MS, Weiss K, et al. Fidaxomicin versus vancomycin for infection with Clostridium difficile in Europe, Canada, and the USA: a double-blind, non-inferiority, randomised controlled trial. Lancet Infect Dis. 2012;12(4):281–9. doi:10.1016/S1473-3099(11)70374-7.

    Article  CAS  PubMed  Google Scholar 

  15. Cornely OA, Miller MA, Fantin B, Mullane K, Kean Y, Gorbach S. Resolution of Clostridium difficile-associated diarrhea in patients with cancer treated with fidaxomicin or vancomycin. J Clin Oncol. 2013;31(19):2493–9. doi:10.1200/JCO.2012.45.5899.

    Article  CAS  PubMed  Google Scholar 

  16. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis. 2012;55(Suppl 2):S154–61. doi:10.1093/cid/cis462.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Micek ST, Schramm G, Morrow L, Frazee E, Personett H, Doherty JA, et al. Clostridium difficile infection: a multicenter study of epidemiology and outcomes in mechanically ventilated patients. Crit Care Med. 2013;41(8):1968–75. doi:10.1097/CCM.0b013e31828a40d5.

    Article  PubMed  Google Scholar 

  18. Bouza E. Consequences of Clostridium difficile infection: understanding the healthcare burden. Clin Microbiol Infect. 2012;18(Suppl 6):5–12. doi:10.1111/1469-0691.12064.

    Article  PubMed  Google Scholar 

  19. Pant C, Anderson MP, Deshpande A, Altaf MA, Grunow JE, Atreja A, et al. Health care burden of Clostridium difficile infection in hospitalized children with inflammatory bowel disease. Inflamm Bowel Dis. 2013;19(5):1080–5. doi:10.1097/MIB.0b013e3182807563.

    Article  PubMed  Google Scholar 

  20. Stranges PM, Hutton DW, Collins CD. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States. Value Health. 2013;16(2):297–304. doi:10.1016/j.jval.2012.11.004.

    Article  PubMed  Google Scholar 

  21. Vonberg RP, Reichardt C, Behnke M, Schwab F, Zindler S, Gastmeier P. Costs of nosocomial Clostridium difficile-associated diarrhoea. J Hosp Infect. 2008;70(1):15–20. doi:10.1016/j.jhin.2008.05.004.

    Article  PubMed  Google Scholar 

  22. Lipp MJ, Nero DC, Callahan MA. Impact of hospital-acquired Clostridium difficile. J Gastroenterol Hepatol. 2012;27(11):1733–7. doi:10.1111/j.1440-1746.2012.07242.x.

    Article  PubMed  Google Scholar 

  23. Institute for the Hospital Remuneration System. Institute for the Hospital Remuneration System-German Diagnosis Related Groups. 2014. http://www.g-drg.de/cms/.

  24. Schulenburg JM, Greiner W, Jost F, Klusen N, Kubin M, Leidl R, Mittendorf T, Rebscher H, Schöffski O. German recommendations on health economic evaluation-Third and updated version of the Hanover Consensus. Gesundh ökon Qual manag. 2007;12:285–90.

    Article  Google Scholar 

  25. Institute for Quality and Efficiency in Health Care. Methods for health economic evaluation. 2009. http://www.iqwig.de/en/methods/methods_papers/health_economic_evaluation.3022.html.

  26. LAUER-FISCHER Taxe. WEBAPO Lauer Taxe. 2014. http://www2.lauer-fischer.de/produkte/lauer-taxe/webapo-infosystem/.

  27. The German Federal Statistical Office. Earnings and labour costs. 2015. https://www.destatis.de/EN/FactsFigures/NationalEconomyEnvironment/EarningsLabourCosts/EarningsEarningsDifferences/Tables/AverageGrossMontlyEarnings.html.

  28. Hübner C, Hübner N, Muhr M, Claus F, Leesch H, Kramer A, Fleßa S. Cost Analysis of Hospitalized Clostridium Difficile-Associated Diarrhea (CDAD). Gesundh ökon Qual manag. 2013;18(2):80–5.

    Article  Google Scholar 

  29. Ghantoji SS, Sail K, Lairson DR, DuPont HL, Garey KW. Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect. 2010;74(4):309–18. doi:10.1016/j.jhin.2009.10.016.

    Article  CAS  PubMed  Google Scholar 

  30. Nesnas J, Whitney L, Ahmand A, Planche T. Cost-effectiveness of fidaxomicin as first-line treatment for Clostridium difficile infection. Oral presentation at ECCMID 2014, O256.

  31. Larrainzar Coghen T, Rodriguez-Pardo D, Almirante B, Rodriguez V, Ferrer C, Pigrau C, Fernandez-Hidalgo N, Puig-Asensio M, Pumarola T, Pahissa A. Recurrent Clostridium difficile infection: clinical relevance, risk factors and prognosis, Poster at ECCMID 2014, PO766.

  32. Cornely OA, Miller MA, Louie TJ, Crook DW, Gorbach SL. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2012;55(Suppl 2):S154–61. doi:10.1093/cid/cis462.

    Article  CAS  Google Scholar 

  33. Dubberke ER, Schaefer E, Reske KA, Zilberberg M, Hollenbeak CS, Olsen MA. Attributable inpatient costs of recurrent Clostridium difficile infections. Infect Control Hosp Epidemiol. 2014;35(11):1400–7. doi:10.1086/678428.

    Article  PubMed  Google Scholar 

  34. Heimann SM, Cornely OA, Wisplinghoff H, Kochanek M, Stippel D, Padosch SA, et al. Candidemia in the intensive care unit: analysis of direct treatment costs and clinical outcome in patients treated with echinocandins or fluconazole. Eur J Clin Microbiol Infect Dis. 2015;34(2):331–8. doi:10.1007/s10096-014-2230-8.

    Article  CAS  PubMed  Google Scholar 

  35. Pepin J, Valiquette L, Gagnon S, Routhier S, Brazeau I. Outcomes of Clostridium difficile-associated disease treated with metronidazole or vancomycin before and after the emergence of NAP1/027. Am J Gastroenterol. 2007;102(12):2781–8. doi:10.1111/j.1572-0241.2007.01539.x.

    Article  PubMed  Google Scholar 

  36. Guastalegname M, Grieco S, Giuliano S, Falcone M, Caccese R, Carfagna P, et al. A cluster of fulminant Clostridium difficile colitis in an intensive care unit in Italy. Infection. 2014;42(3):585–9. doi:10.1007/s15010-014-0597-1.

    Article  CAS  PubMed  Google Scholar 

  37. Konijeti GG, Sauk J, Shrime MG, Gupta M, Ananthakrishnan AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis. 2014;58(11):1507–14. doi:10.1093/cid/ciu128.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Nathwani D, Cornely OA, Van Engen AK, Odufowora-Sita O, Retsa P, Odeyemi IA. Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection. J Antimicrob Chemother. 2014;. doi:10.1093/jac/dku257.

    PubMed Central  Google Scholar 

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Acknowledgments

This study was supported by an unrestricted research grant from MSD Sharp and Dohme GmbH, Germany. It was designed, planned, and performed by the academic authors and students of the UHC.

Conflict of interest

S.M.H. has received research and travel grants from Astellas, Gilead and Merck, and travel grants from Pfizer. O.A.C. was supported by the German Federal Ministry of Research and Education (BMBF grant 01KN1106); received research grants from 3M, Actelion, Astellas, Basilea, Bayer, Celgene, Cubist/Optimer, Genzyme, Gilead, GSK, Merck/MSD, Miltenyi, Pfizer, Quintiles, Shionogi, Viropharma; was a consultant to 3M, Astellas, Basilea, Cidara, Cubist/Optimer, Da Volterra, Daiichi Sankyo, F2G, Genentech, Gilead, GSK, Merck/MSD, Merck Serono, Pfizer, Rempex, Sanofi Pasteur and Summit/Vifor; and received lecture honoraria from Astellas, Gilead, Merck/MSD, and Pfizer. J.J.V. was supported by the German Federal Ministry of Research and Education (BMBF grant 01KI0771) and the German Centre for Infection Research. J.J.V. has received research grants from Astellas, Gilead Sciences, Infectopharm, Merck/MSD, and Pfizer; and served on the speakers’ bureau of Astellas, Merck/MSD, Gilead Sciences, and Pfizer. M.J.G.T.V. has served at the speakers’ bureau of Pfizer, Merck/MSD, Gilead Sciences, and Astellas Pharma; received research funding from 3M, Astellas Pharma and Gilead Sciences; and was a consultant to Berlin Chemie.

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Authors and Affiliations

  1. Department I of Internal Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    S. M. Heimann, J. J. Vehreschild, O. A. Cornely, M. Hallek, F. Müller, B. Franke & M. J. G. T. Vehreschild

  2. German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany

    J. J. Vehreschild, O. A. Cornely, B. Franke & M. J. G. T. Vehreschild

  3. Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany

    H. Wisplinghoff & N. Jazmati

  4. Clinical Trials Centre Cologne, ZKS Köln, BMBF01KN1106, and Cluster of Excellence, Cellular Stress Responses in Aging-Associated Diseases, CECAD, University of Cologne, Herderstraße 52-54, 50931, Cologne, Germany

    O. A. Cornely

  5. Center for Integrated Oncology Köln Bonn, CIO Köln Bonn, University Hospital of Cologne, 50924, Cologne, Germany

    O. A. Cornely, M. Hallek, R. Goldbrunner, T. Goeser & A. Hölscher

  6. Department of Neurosurgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    R. Goldbrunner

  7. Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    B. W. Böttiger & S. Wingen

  8. Department of Gastroenterology and Hepatology, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    T. Goeser

  9. Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    A. Hölscher

  10. Department of Cardiology, Heart Center, University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    S. Baldus

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  1. S. M. Heimann
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  2. J. J. Vehreschild
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  3. O. A. Cornely
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  7. B. W. Böttiger
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  8. T. Goeser
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  9. A. Hölscher
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  10. S. Baldus
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  11. F. Müller
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  12. N. Jazmati
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  13. S. Wingen
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  15. M. J. G. T. Vehreschild
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Correspondence to M. J. G. T. Vehreschild.

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Heimann, S.M., Vehreschild, J.J., Cornely, O.A. et al. Economic burden of Clostridium difficile associated diarrhoea: a cost-of-illness study from a German tertiary care hospital. Infection 43, 707–714 (2015). https://doi.org/10.1007/s15010-015-0810-x

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