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The potential economic value of screening hospital admissions for Clostridium difficile

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Abstract

Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51–85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53–272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system.

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References

  1. Heinlen L, Ballard JD (2010) Clostridium difficile infection. American Journal of the Medical Sciences 340(3):247–252

    Article  PubMed  Google Scholar 

  2. Missaghi B, Valentia AJ, Owens RCJ (2008) Clostridium difficile infection: a critical overview. Current Infectious Disease Reports 10:165–173

    Article  PubMed  Google Scholar 

  3. McGlone SM, Bailey RR, Zimmer SM, Popovich MJ, Tian Y, Ufberg PJ, Muder RR, Lee BY (2012) The economic burden of Clostridium difficile. Clin Microbiol Infect. 18(3):282–289

    Google Scholar 

  4. Dubberke ER, Wertheimer AI (2009) Review of current literature on the economic burden of Clostridium difficile infection. Infect Control Hosp Epidemiol 30(1):57–66

    Article  PubMed  Google Scholar 

  5. Kelly CP, LaMont JT (2008) Clostridium difficile—more difficult than ever. N Engl J Med 359:1932–1940

    Article  CAS  PubMed  Google Scholar 

  6. McFarland LV, Mulligan ME, Kowk RYY, Stamm WE (1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320(4):204–210

    Article  CAS  PubMed  Google Scholar 

  7. Riggs MM, Sethi AK, Zabarsky TF, Ec E, Jump RLP, Donskey CJ (2007) Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 45:992–998

    Article  PubMed  Google Scholar 

  8. Clabots CR, Johnson S, Olson MM, Peterson LR, Gerding DN (1992) Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 166:561–567

    Article  CAS  PubMed  Google Scholar 

  9. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH (2010) Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infections Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 31(5):431–455

    Article  PubMed  Google Scholar 

  10. Sloan LM, Duresko BJ, Gustafson DR, Rosenblatt JE (2008) Comparison of real-time PCR for detection of the tcdC gene with four toxin immunoassays and culture in diagnosis of Clostridium difficile infection. J Clin Microbiol 46(6):1996–2001

    Article  CAS  PubMed  Google Scholar 

  11. Stamper PD, Alcabasa R, Aird D, Babiker W, Wehrlin J, Ikpeama I, Carroll KC (2009) Comparison of a commercial real-time PCR assay for tcdB detection to a cell culture cytotoxicity assay and toxigenic culture for direct detection of toxin-producing Clostridium difficile in clinical samples. J Clin Microbiol 47(2):373

    Article  CAS  PubMed  Google Scholar 

  12. Stamper PD, Babiker W, Alcabasa R, Aird D, Wehrlin J, Ikpeama I, Gluck L, Carroll KC (2009) Evaluation of a new commercial TaqMan PCR assay for direct detection of the Clostridium difficile toxin B gene in clinical stool samples. J Clin Microbiol 47(12):3846

    Article  CAS  PubMed  Google Scholar 

  13. Curry SR, Gee JL, Hamilton TM, Henderson TK, Brown NT, Marsh JW, Shutt KA, Brooks MM, Pasculle AW, Muto CA, Harrison LH (2011) Peri-rectal swab surveillance for Clostridium difficile using selective broth pre-amplification and real-time PCR detection of tcdB. J Clin Microbiol 49(11):3788–3793

    Google Scholar 

  14. United States Department of Health & Human Services (2009) HCUP facts and figures: statistics on hospital-based care in the United States, 2009. AHRQ: Agency for Healthcare Research and Quality. http://www.hcup-us.ahrq.gov/reports.jsp. Accessed 2 February 2012

  15. Leffler DA, LaMont JT (2009) Treatment of Clostridium difficile-associated disease. Gastroenterology 136:1899–1912

    Article  CAS  PubMed  Google Scholar 

  16. Ramsey S, Veenstra D, Clarke L, Gandhi S, Hirsch M, Penson D (2005) Is combined androgen blockade with bicalutamide cost-effective compared with combined androgen blockade with flutamide? Urology 66(4):835–839

    Article  PubMed  Google Scholar 

  17. Penson D, Ramsey S, Veenstra D, Clarke L, Gandhi S, Hirsch M (2005) The cost-effectiveness of combined androgen blockade with bicalutamide and luteinizing hormone releasing agonist in men with metastatic prostate cancer. J Urol 174(2):547–552

    Article  PubMed  Google Scholar 

  18. Hayes JL, Hansen P (2007) Is laparoscopic colectomy for cancer cost-effective relative to open colectomy? ANZ J Surg 77(9):782–786

    Article  PubMed  Google Scholar 

  19. Neumann PJ, Sandberg EA, Bell CM, Stone PW, Chapman RH (2000) Are pharmaceuticals cost-effective? A review of the evidence. Heal Aff 19(2):92–109

    Article  CAS  Google Scholar 

  20. Graves N (2004) Economics and preventing hospital-acquired infection. Emerg Infect Dis 10(4):561–566

    Article  PubMed  Google Scholar 

  21. Marciniak C, Chen D, Stein AC, Semik PE (2006) Prevalence of Clostridium difficile colonization at admission to rehabilitation. Arch Phys Med Rehabil 87(8):1086–1890

    Article  PubMed  Google Scholar 

  22. Loo VG, Bourgault A-M, Poirier L, Lamothe F, Michaud S, Turgeon N, Toye B, Beaudoin A, Frost EH, Gilca R, Brassard P, Dendukuri N, Beliveau C, Oughton M, Brukner I, Dascal A (2011) Host and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 365:1693–1703

    Article  CAS  PubMed  Google Scholar 

  23. Shim JK, Johnson S, Samore MH, Bliss DZ, Gerding DN (1998) Primary symptomless colonisation by Clostridium difficile and decreased risk of subsequent diarrhoea. Lancet 351:633–636

    Article  CAS  PubMed  Google Scholar 

  24. Kyne L, Hamel MB, Polavaram R, Kelly CP (2002) Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 34:346–353

    Article  PubMed  Google Scholar 

  25. Pepin J, Valiquette L, Cossette B (2005) Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 173(9):1037

    Article  PubMed  Google Scholar 

  26. Song X, Bartlett JG, Speck K, Naegeli A, Carroll KC, Perl TM (2008) Rising economic impact of Clostridium difficile—associated disease in adult hopsitalized patient population. Infect Control Hosp Epidemiol 29(9):823–828

    Article  CAS  PubMed  Google Scholar 

  27. Forster AJ, Taljarrd M, Oake N, Wilson K, Roth V, van Walraven C (2012) The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital. CMAJ 184(1):37–42

    Article  PubMed  Google Scholar 

  28. Pakyz A, Carroll NV, Harpe SE, Oinonen M, Polk RE (2011) Economic impact of Clostridium difficile infection in a mulithospital cohort of academic health centers. Pharmacotherapy 31(6):546–551

    Article  PubMed  Google Scholar 

  29. Vonberg R-P, Reichardt C, Behnke M, Schwab F, Zindler S, Gastmeier P (2008) Costs of nosocomial Clostridium difficile-associated diarrhoea. J Hosp Infect 70(1):15–20

    Article  PubMed  Google Scholar 

  30. Ghantoji SS, Sail K, Lairson D, DuPont HL, Garey KW (2010) Economic healthcare costs of Clostridium difficile infection: a systematic review. J Hosp Infect 74:309–318

    Article  CAS  PubMed  Google Scholar 

  31. McGlone SM, Bailey RR, Zimmer SM, Popovich MJ, Tian Y, Ufberg PJ, Muder RR, Lee BY (2012) The economic burden of Clostridium difficile. Clin Microbiol Infect 18(3):282–289

    Article  CAS  PubMed  Google Scholar 

  32. Lanzas C, Dubberke ER, Lu Z, Reske KA, Grohn YT (2011) Epidemiological model for Clostridium difficile transmission in healthcare settings. Infect Control Hosp Epidemiol 32(6):553–561

    Article  CAS  PubMed  Google Scholar 

  33. Lee BY, Bailey RR, Smith KJ, Muder RR, Strotmeyer ES, Lewis GJ, Ufberg PJ, Song Y, Harrison LH (2010) Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 31(6):598–606

    Article  PubMed  Google Scholar 

  34. Lee BY, McGlone SM, Doi Y, Bailey RR, Harrison LH (2011) Economic value of Acinetobacter baumannii screening in the intensive care unit (ICU). Clin Microbiol Infect 17(11):1691–1697

    Article  CAS  PubMed  Google Scholar 

  35. Lee BY, Song Y, McGlone SM, Bailey RR, Feura J, Tai JHY, Lewis GJ, Wiringa AE, Smith KJ, Muder RR, Harrison LH, Piraino B (2011) The economic value of screening haemodialysis patients for methicillin-resistant Staphylococcus aureus in the USA. Clin Microbiol Infect 17(11):1717–1726

    Article  CAS  PubMed  Google Scholar 

  36. Lee BY, Tsui B, Bailey RR, Smith KJ, Muder RR, Lewis GJ, Harrison LH (2009) Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 30(12):1158–1165

    Article  PubMed  Google Scholar 

  37. Lee BY, Wiringa AE, Bailey RR, Goyal V, Lewis GJ, Tsui B, Smith KJ, Muder RR (2010) Screening cardiac surgery patients for MRSA: an economic computer model. Am J Manag Care 16(7):e163–e173

    PubMed  Google Scholar 

  38. Lee BY, Wiringa AE, Bailey RR, Goyal V, Tsui B, Lewis GJ, Muder RR, Harrison LH (2010) The economic effect of screening orthopedic surgery patients preoperatively for methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 31(11):1130–1138

    Article  PubMed  Google Scholar 

  39. Kato H, Kita H, Karasawa T, Maegawa T, Koino Y, Takakuwa H, Saikai T, Kobayashi K, Yamagishi T, Nakamura S (2001) Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis. J Med Microbiol 50(8):720–727

    CAS  PubMed  Google Scholar 

  40. Nakamura S, Mikawa M, Nakashio S, Takabatake M, Okado I, Yamakawa K, Serikawa T, Okumura S, Nishida S (1981) Isolation of Clostridium difficile from the feces and the antibody in sera of young and elderly adults. Microbiol Immunol 25(4):345–351

    CAS  PubMed  Google Scholar 

  41. Ozaki E, Kato H, Kita H, Karasawa T, Maegawa T, Koino Y, Matsumoto K, Takada T, Nomoto K, Tanaka R, Nakamura S (2004) Clostridium difficile colonization in healthy adults: transient colonization and correlation with enterococcal colonization. J Med Microbiol 53(Pt 2):167–172

    Article  PubMed  Google Scholar 

  42. Viscidi R, Willey S, Bartlett JG (1981) Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology 81(1):5–9

    CAS  PubMed  Google Scholar 

  43. Lee BY (2008) Digital decision making: computer models and antibiotic prescribing in the twenty-first century. Clin Infect Dis 46(8):1139–1141

    Article  PubMed  Google Scholar 

  44. Abad C, Fearday A, Safdar N (2010) Adverse events of isolation in hospitalised patients: a systematic review. J Hosp Infect 76:97–102

    Article  CAS  PubMed  Google Scholar 

  45. Puzniak LA, Gillespie KN, Leet T, Kollef M, Mundy LM (2004) A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 25:418–424

    Article  PubMed  Google Scholar 

  46. Bureau of Labor Statistics (2010) Occupational employment statistics: May 2009 national occupational employment and wage estimates, United States. U.S. Bureau of Labor Statistics Division of Occupational Employment Statistics. http://stat.bls.gov/oes/2008/may/oes_nat.htm#b00-0000. Accessed November 2011

  47. American Medical Association (2011) CPT code/relative value search. https://ocm.ama-assn.org/OCM/CPTRelativeValueSearch.do. Accessed April 27 2011

  48. PDR (2010) Red Book Pharmacy's fundamental reference. Thompson Reuters (Healthcare), Inc., Montvale, NJ

  49. Gold MR, Franks P, McCoy KI, Fryback DG (1998) Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Medical Care 36(6):778–792

    Article  CAS  PubMed  Google Scholar 

  50. Fujitani S, George WL, Murthy AR (2011) Comparison of clinical severity score indices for Clostridium difficile infection. Infect Control Hosp Epidemiol 32(3):220–228

    Article  PubMed  Google Scholar 

  51. Henrich TJ, Krakower D, Bitton A, Yokoe DS (2009) Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis 15(13):415–422

    Article  PubMed  Google Scholar 

  52. Barbut F, Gariazzo B, Bonne L, Lalande V, Burghoffer B, Luiuz R, Petit H-C (2007) Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: results of a retrospective study, 2000–2004. Infect Control Hosp Epidemiol 28(2):131–139

    Article  PubMed  Google Scholar 

  53. Ricciardi R, Rothenberger DA, Madoff RD, Baxter NN (2007) Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 142(7):624–631

    Article  PubMed  Google Scholar 

  54. Jaber MR, Olfsson S, Fung WL, Reeves ME (2008) Clinical review of the management of fulminant Clostridium difficile infection. Am J Gastroenterol 103:3195–3203

    Article  PubMed  Google Scholar 

  55. Pepin J, Vo TT, Boutros M, Marcotte E, Dial S, Bube S, Vasilevsky C-A, McFadden N, Patino C, Labbe A-C (2009) Risk factors for mortality following emergency colectomy for fulminant Clostridium difficile infection. Dis Colon Rectum 52(3):400–405

    Article  PubMed  Google Scholar 

  56. Lamontagne F, Labbe A-C, Haeck O, Lesur O, Lalancette M, Patino C, Leblanc M, Laverdiere M, Pepin J (2007) Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg 245(2):267–272

    Article  PubMed  Google Scholar 

  57. Barbut F, Richard A, Hamadi K, Chomette V, Burghoffer B, Petit J-C (2000) Epidemiology of recurrences or reinfections of Clostridium difficile-associated diarrhea. J Clin Microbiol 38(6):2386–2388

    CAS  PubMed  Google Scholar 

  58. Fekety R, McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Mulligan ME (1997) Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 24(3):324–333

    Article  CAS  PubMed  Google Scholar 

  59. Bauer MP, Kuijper EJ, van Dissel JT (2009) European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI). Clin Microbiol Infect 15:1067–1079

    Article  CAS  PubMed  Google Scholar 

  60. McFarland LV, Elmer GW, Surawicz CM (2002) Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 97(7):1769–1775. doi:10.1111/j.1572-0241.2002.05839.x

    Article  CAS  PubMed  Google Scholar 

  61. Jernigan JA, Clemence MA, Stott GA, Titus MG, Alexander CH, Palumbo CM, Farr BM (1995) Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 16(12):686–696

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the Pennsylvania Department of Health (grant #4100047864) and the National Institute of General Medical Sciences Models of Infectious Disease Agent Study (MIDAS) grant 1U54GM088491-0109. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

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The authors are not aware of any substantial conflict of interest.

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Authors and Affiliations

  1. Public Health Computational and Operations Research (PHICOR), University of Pittsburgh, 3520 Forbes Avenue, First Floor, Pittsburgh, PA, 15213, USA

    S. M. Bartsch & B. Y. Lee

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    S. M. Bartsch & B. Y. Lee

  3. Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    S. R. Curry

  4. Infectious Disease Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA, USA

    L. H. Harrison

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  1. S. M. Bartsch
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  2. S. R. Curry
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Correspondence to S. M. Bartsch.

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Bartsch, S.M., Curry, S.R., Harrison, L.H. et al. The potential economic value of screening hospital admissions for Clostridium difficile . Eur J Clin Microbiol Infect Dis 31, 3163–3171 (2012). https://doi.org/10.1007/s10096-012-1681-z

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