Epidemiological and economic burden of Clostridium difficile in the United States: estimates from a modeling approach

Kamal Desai, Swati B Gupta, Erik R Dubberke, Vimalanand S Prabhu, Chantelle Browne, T Christopher Mast, Kamal Desai, Swati B Gupta, Erik R Dubberke, Vimalanand S Prabhu, Chantelle Browne, T Christopher Mast

Abstract

Background: Despite a large increase in Clostridium difficile infection (CDI) severity, morbidity and mortality in the US since the early 2000s, CDI burden estimates have had limited generalizability and comparability due to widely varying clinical settings, populations, or study designs.

Methods: A decision-analytic model incorporating key input parameters important in CDI epidemiology was developed to estimate the annual number of initial and recurrent CDI cases, attributable and all-cause deaths, economic burden in the general population, and specific number of high-risk patients in different healthcare settings and the community in the US. Economic burden was calculated adopting a societal perspective using a bottom-up approach that identified healthcare resources consumed in the management of CDI.

Results: Annually, a total of 606,058 (439,237 initial and 166,821 recurrent) episodes of CDI were predicted in 2014: 34.3 % arose from community exposure. Over 44,500 CDI-attributable deaths in 2014 were estimated to occur. High-risk susceptible individuals representing 5 % of the total hospital population accounted for 23 % of hospitalized CDI patients. The economic cost of CDI was $5.4 billion ($4.7 billion (86.7 %) in healthcare settings; $725 million (13.3 %) in the community), mostly due to hospitalization.

Conclusions: A modeling framework provides more comprehensive and detailed national-level estimates of CDI cases, recurrences, deaths and cost in different patient groups than currently available from separate individual studies. As new treatments for CDI are developed, this model can provide reliable estimates to better focus healthcare resources to those specific age-groups, risk-groups, and care settings in the US where they are most needed. (Trial Identifier ClinicaTrials.gov: NCT01241552).

Keywords: Community; Cost; Hospital; Long-term care; NAP1.

Figures

Fig. 1
Fig. 1
Diagram of decision-analytic model of CDI showing natural history for a given age and risk group in a healthcare setting. (*) Pathways for B, C, D are the same as for A, but downstream parameters for mortality and recurrence depend on strain. (**) Pathway for second and subsequent recurrences follows the same natural history as first recurrence although the probability of 2nd + recurrence is greater than 1st

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