Bhaila R, Moss E, Heinrich K, Vietri J. Breakdown of costs attributable to clostridioides difficile infection in the US: results from a systematic literature review. Poster presented at the 2020 ISPOR Virtual Conference; May 2020. [abstract] Value Health. 2020 May 1; 23(Suppl 1):S145. doi: 10.1016/j.jval.2020.04.1183.

BACKGROUND: A previous systematic literature review (SLR) of Clostridioides difficile infection (CDI) global economic burden, conducted up to 2014, showed considerable costs of CDI. This SLR summarizes breakdown of CDI-attributable economic burden literature in the United States (US) published since 2014.

METHODS: An SLR using terms for CDI, costs, and/or healthcare resource use was conducted across relevant databases from 1 January 2014 to 15 August 2018 without language or geographical restrictions, and supplemented by conference and HTA website searches. Costs attributed to CDI by study authors and differences in regression-adjusted or matched costs between CDI and non-CDI cohorts were extracted.

RESULTS: Of 2,342 sources screened, 7 articles included CDI-attributable costs for US patients. The overall CDI attributable cost ranged from 1.2-3.3 times (incremental $1,700-$80,178) the costs of non-CDI patients, although study methods varied. Three studies presented detailed breakdown of direct costs. No indirect costs were identified. Two were retrospective database studies with one using insurance claims data. One study in primary CDI patients reported that 87% ($21,096) of the $24,205 overall CDI-attributable costs over 6 months was due to inpatient services, followed by outpatient ($1,520) and emergency services ($555). Another study found inpatient costs represented 91% ($73,045) of total CDI-attributable costs ($80,178). Further confirmation of inpatient costs being the predominant cost driver in CDI was provided by third study conducted in nursing homes over two months of follow-up (55% [$8,243] of total CDI attributable costs [$14,977]), in which the skilled nursing facility ($3,487) was the next major cost component.

CONCLUSIONS: Consistent with prior SLR, recent US studies demonstrate substantial direct medical costs attributable to CDI, with inpatient costs representing the largest proportion (55%-91%). However, non-inpatient services still account for $555-$7,133 in CDI-attributable costs. Future research should also assess the indirect cost component of the CDI-attributable economic burden in the US.

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