Direct cost of health care for individuals with community associated Clostridium difficile infections: A population-based cohort study


Autoři: Harminder Singh aff001;  Zoann Nugent aff001;  A Walkty aff002;  B Nancy Yu aff004;  Lisa M. Lix aff004;  Laura E. Targownik aff001;  Charles N. Bernstein aff001;  Julia Witt aff006
Působiště autorů: University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada aff001;  Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada aff002;  CancerCare Manitoba, Research Institute, Winnipeg, Manitoba, Canada aff003;  Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada aff004;  Public Health Branch, Manitoba Health, Seniors and Active Living, Winnipeg, Manitoba, Canada aff005;  Department of Economics, University of Manitoba, Winnipeg, Manitoba, Canada aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224609

Souhrn

Background

Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI.

Methods

All individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI.

Results

Of all CDIs, 30–40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209–489).

Conclusions

Health care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.

Klíčová slova:

Clostridium difficile – Cost-effectiveness analysis – Hospitalizations – Inpatients – Physicians – Vancomycin – Manitoba


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2019 Číslo 11