PGI16 BREAKDOWN OF COSTS ATTRIBUTABLE TO CLOSTRIDIOIDES DIFFICILE INFECTION IN THE US: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW

Abstract

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 CDI-attributable economic burden literature in the United States (US) published since 2014. 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, including components of total costs (e.g., inpatient-, outpatient- and indirect costs, etc.) where available. Of 2,342 sources screened, 7 articles included CDI-attributable costs for US patients. Overall CDI-attributable cost ranged from 1.2-3.3 times that of non-CDI patients (incremental $1,700-$80,178), although study methods varied. Three studies presented detailed breakdown of direct costs; none included indirect costs. 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). The third study, conducted in nursing homes over two months of follow-up, also found inpatient services were the predominant driver (55% [$8,243]) of total CDI-attributable costs ($14,977), with skilled nursing facility ($3,487) the next largest cost component. Consistent with the 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 incorporate CDI-attributable indirect costs to more completely describe the economic burden of CDI.