#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

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: https://doi.org/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


Zdroje

1. To KB, Napolitano LM. Clostridium difficile Infection: Update on Diagnosis, Epidemiology, and Treatment Strategies. Surgical infections. 2014;15(5):490–502. Epub 2014/10/15. doi: 10.1089/sur.2013.186 25314344.

2. Le Monnier A, Zahar JR, Barbut F. Update on Clostridium difficile infections. Medecine et maladies infectieuses. 2014;44(8):354–65. Epub 2014/08/27. doi: 10.1016/j.medmal.2014.04.002 25156678.

3. Lessa FC, Gould CV, McDonald LC. Current Status of Clostridium difficile Infection Epidemiology. Clinical Infectious Diseases. 2012;55(suppl 2):S65–S70. doi: 10.1093/cid/cis319 22752867

4. Reveles KR, Lee GC, Boyd NK, Frei CR. The rise in Clostridium difficile infection incidence among hospitalized adults in the United States: 2001–2010. American journal of infection control. 2014;42(10):1028–32. Epub 2014/10/04. doi: 10.1016/j.ajic.2014.06.011 25278388.

5. Dupont HL. Diagnosis and management of Clostridium difficile infection. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association. 2013;11(10):1216–23; quiz e73. Epub 2013/04/02. doi: 10.1016/j.cgh.2013.03.016 23542332.

6. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, et al. The Epidemiology of Community-Acquired Clostridium difficile Infection: A Population-Based Study. The American journal of gastroenterology. 2011;107:89. doi: 10.1038/ajg.2011.398 22108454

7. Nanwa N, Kendzerska T, Krahn M, Kwong JC, Daneman N, Witteman W, et al. The economic impact of Clostridium difficile infection: a systematic review. The American journal of gastroenterology. 2015;110(4):511–9. Epub 2015/04/08. doi: 10.1038/ajg.2015.48 25848925.

8. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2018;66(7):987–94. Epub 2018/03/22. doi: 10.1093/cid/ciy149 29562266.

9. Choi KB, Suh KN, Muldoon KA, Roth VR, Forster A. Hospital Acquired Clostridium difficile Infection (HA-CDI): An institutional costing analysis. The Journal of hospital infection. 2019. Epub 2019/01/29. doi: 10.1016/j.jhin.2019.01.019 30690051.

10. Mollard S, Lurienne L, Heimann SM, Bandinelli PA. The Burden of Clostridium difficile Infection During Inpatient Stays in the United States between 2012 and 2016. The Journal of hospital infection. 2019. Epub 2019/01/29. doi: 10.1016/j.jhin.2019.01.020 30690052.

11. Rodrigues R, Barber GE, Ananthakrishnan AN. A Comprehensive Study of Costs Associated With Recurrent Clostridium difficile Infection. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America. 2017;38(2):196–202. Epub 2016/11/08. doi: 10.1017/ice.2016.246 27817758.

12. Dubberke ER, Butler AM, Nyazee HA, Reske KA, Yokoe DS, Mayer J, et al. The impact of ICD-9-CM code rank order on the estimated prevalence of Clostridium difficile infections. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2011;53(1):20–5. Epub 2011/06/10. doi: 10.1093/cid/cir246 21653298; PubMed Central PMCID: PMC3110281.

13. Goto M, Ohl ME, Schweizer ML, Perencevich EN. Accuracy of administrative code data for the surveillance of healthcare-associated infections: a systematic review and meta-analysis. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 2014;58(5):688–96. Epub 2013/11/13. doi: 10.1093/cid/cit737 24218103.

14. Singh H, Nugent Z, Yu BN, Lix LM, Targownik L, Bernstein C. Hospital discharge abstracts have limited accuracy in identifying occurrence of Clostridium difficile infections among hospitalized individuals with inflammatory bowel disease: A population-based study. PloS one. 2017;12(2):e0171266. Epub 2017/02/16. doi: 10.1371/journal.pone.0171266 28199401.

15. Pak TR, Chacko KI, O'Donnell T, Huprikar SS, van Bakel H, Kasarskis A, et al. Estimating Local Costs Associated With Clostridium difficile Infection Using Machine Learning and Electronic Medical Records. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America. 2017;38(12):1478–86. Epub 2017/11/07. doi: 10.1017/ice.2017.214 29103378; PubMed Central PMCID: PMC5923033.

16. Lambert PJ, Dyck M, Thompson LH, Hammond GW. Population-based surveillance of Clostridium difficile infection in Manitoba, Canada, by using interim surveillance definitions. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America. 2009;30(10):945–51. Epub 2009/09/08. doi: 10.1086/605719 19732008.

17. Manitoba Health HLaS. Manitoba Health, Healthy Living and Seniors Population Report June 1, 2015. Winnipeg, Manitoba: Government of Manitoba; 2015.

18. Kozyrskyj AL, Mustard CA. Validation of an electronic, population-based prescription database. AnnPharmacother. 1998;32(11):1152–7.

19. Roos LL, Mustard CA, Nicol JP, McLerran DF, Malenka DJ, Young TK, et al. Registries and administrative data: organization and accuracy. MedCare. 1993;31(3):201–12.

20. Robinson JR, Young TK, Roos LL, Gelskey DE. Estimating the burden of disease. Comparing administrative data and self-reports. MedCare. 1997;35(9):932–47.

21. Bernstein CN, Blanchard JF, Rawsthorne P, Wajda A. Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study. AmJEpidemiol. 1999;149(10):916–24.

22. Rea MC, O'Sullivan O, Shanahan F, O'Toole PW, Stanton C, Ross RP, et al. Clostridium difficile Carriage in Elderly Subjects and Associated Changes in the Intestinal Microbiota. Journal of clinical microbiology. 2012;50(3):867–75. doi: 10.1128/JCM.05176-11 22162545

23. Galdys AL, Nelson JS, Shutt KA, Schlackman JL, Pakstis DL, Pasculle AW, et al. Prevalence and duration of asymptomatic Clostridium difficile carriage among healthy subjects in Pittsburgh, Pennsylvania. Journal of clinical microbiology. 2014;52(7):2406–9. Epub 2014/04/25. doi: 10.1128/JCM.00222-14 24759727; PubMed Central PMCID: PMC4097745.

24. Alfa MJ, Swan B, VanDekerkhove B, Pang P, Harding GK. The diagnosis of Clostridium difficile-associated diarrhea: comparison of Triage C. difficile panel, EIA for Tox A/B and cytotoxin assays. Diagnostic microbiology and infectious disease. 2002;43(4):257–63. Epub 2002/08/02. doi: 10.1016/s0732-8893(02)00413-3 12151184.

25. Walkty A, Lagace-Wiens PR, Manickam K, Adam H, Pieroni P, Hoban D, et al. Evaluation of an algorithmic approach in comparison with the Illumigene assay for laboratory diagnosis of Clostridium difficile infection. Journal of clinical microbiology. 2013;51(4):1152–7. Epub 2013/02/01. doi: 10.1128/JCM.03203-12 23363829; PubMed Central PMCID: PMC3666773.

26. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America. 2007;28(2):140–5. Epub 2007/02/01. doi: 10.1086/511798 17265394.

27. Phatharacharukul P, Thongprayoon C, Cheungpasitporn W, Edmonds PJ, Mahaparn P, Bruminhent J. The Risks of Incident and Recurrent Clostridium difficile-Associated Diarrhea in Chronic Kidney Disease and End-Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis. Digestive diseases and sciences. 2015;60(10):2913–22. Epub 2015/05/20. doi: 10.1007/s10620-015-3714-9 25986528.

28. Qu HQ, Jiang ZD. Clostridium difficile infection in diabetes. Diabetes research and clinical practice. 2014;105(3):285–94. Epub 2014/07/13. doi: 10.1016/j.diabres.2014.06.002 25015315.

29. Piper MS, Saad RJ. Diabetes Mellitus and the Colon. Current treatment options in gastroenterology. 2017;15(4):460–74. Epub 2017/10/25. doi: 10.1007/s11938-017-0151-1 29063998; PubMed Central PMCID: PMC6049816.

30. Chateau D, Metge C, Prior H, Soodeen RA. Learning from the census: the Socio-economic Factor Index (SEFI) and health outcomes in Manitoba. Canadian journal of public health = Revue canadienne de sante publique. 2012;103(8 Suppl 2):S23–7. Epub 2012/01/01. 23618067.

31. Nanwa N, Sander B, Krahn M, Daneman N, Lu H, Austin PC, et al. A population-based matched cohort study examining the mortality and costs of patients with community-onset Clostridium difficile infection identified using emergency department visits and hospital admissions. PloS one. 2017;12(3):e0172410. Epub 2017/03/04. doi: 10.1371/journal.pone.0172410 28257438; PubMed Central PMCID: PMC5336215.

32. Gabriel L, Beriot-Mathiot A. Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review. The Journal of hospital infection. 2014;88(1):12–21. Epub 2014/07/06. doi: 10.1016/j.jhin.2014.04.011 24996516.

33. Levy AR, Szabo SM, Lozano-Ortega G, Lloyd-Smith E, Leung V, Lawrence R, et al. Incidence and Costs of Clostridium difficile Infections in Canada. Open forum infectious diseases. 2015;2(3):ofv076. Epub 2015/07/21. doi: 10.1093/ofid/ofv076 26191534; PubMed Central PMCID: PMC4503917.

34. Stevens VW, Nelson RE, Schwab-Daugherty EM, Khader K, Jones MM, Brown KA, et al. Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection. JAMA internal medicine. 2017;177(4):546–53. Epub 2017/02/07. doi: 10.1001/jamainternmed.2016.9045 28166328.

35. Louie TJ, Miller MA, Mullane KM, Weiss K, Lentnek A, Golan Y, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. The New England journal of medicine. 2011;364(5):422–31. Epub 2011/02/04. doi: 10.1056/NEJMoa0910812 21288078.

36. Le P, Nghiem VT, Mullen PD, Deshpande A. Cost-Effectiveness of Competing Treatment Strategies for Clostridium difficile Infection: A Systematic Review. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America. 2018;39(4):412–24. Epub 2018/02/22. doi: 10.1017/ice.2017.303 29463339; PubMed Central PMCID: PMC5869164.


Článek vyšel v časopise

PLOS One


2019 Číslo 11
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#