Quality of life and utility decrement associated with Clostridium difficile infection in a French hospital setting

Frédéric Barbut, Tatiana Galperine, Philippe Vanhems, Alban Le Monnier, Bernard Durand-Gasselin, Frédérique Canis, Viviane Jeanbat, Anne Duburcq, Sarah Alami, Caroline Bensoussan, Francis Fagnani, Frédéric Barbut, Tatiana Galperine, Philippe Vanhems, Alban Le Monnier, Bernard Durand-Gasselin, Frédérique Canis, Viviane Jeanbat, Anne Duburcq, Sarah Alami, Caroline Bensoussan, Francis Fagnani

Abstract

Background: Clostridium difficile infection (CDI) is associated with a substantial Quality of life impact on patients that has not been so far measured with a generic validated instrument.

Methods: A prospective study was performed in 7 French acute-care settings in patients presenting with a bacteriologically-confirmed CDI. The EQ-5D-3 L was filled in by patients at 7 ± 2 days after CDI diagnosis to describe their state of health at that date as well as their state of health immediately before the CDI episode (baseline). Individual utility decrement was obtained by subtracting the corresponding utilities. The Quality Adjusted Life Year (QALY) loss was calculated by multiplying the days spent from baseline to the date of the interview, by the decrement of utility. A multivariate analysis of variance of the utility decrement according to CDI and patients characteristics was performed.

Results: Eighty patients were enrolled (mean age: 69.4 years, 55% females). The utility scores dropped from a mean 0.542 (SD: 0.391) at baseline to 0.050 (SD: 0.404) during the CDI episode with a mean adjusted utility decrement of 0.492 (SD: 0.398) point. This decrement increased significantly with CDI severity (Zar score ≥ 3) (p = 0.001), in patients with a positive baseline utility (p = 0.032), in women as compared to men (p = 0.041) and in patients aged more than 65 years (p = 0.041). No association with the Charlson index was found. The associated QALY loss not integrating the excess mortality was 0.028 (SD: 0.053).

Conclusions: The impact on quality of life of CDI episodes is major and translates in a substantial QALY loss despite their short duration.

Keywords: Clostridium difficile; EQ-5D; France; Health-related quality of life.

Conflict of interest statement

SA and CB are employees of MSD France. VJ, AD and FF are employees of CEMKA.

References

    1. Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7:52–36. doi: 10.1038/nrmicro2164.
    1. Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008;46:S12–S18. doi: 10.1086/521863.
    1. Lessa FC, Winston LG, McDonald LC, Emerging Infections Program C. difficile Surveillance Team Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:2369–2370. doi: 10.1056/NEJMoa1408913.
    1. Wiegand PN, Nathwani D, Wilcox MH, Stephens J, Shelbaya A, Haider S. Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility acquired infection. J Hosp Infect. 2012;81:1–14. doi: 10.1016/j.jhin.2012.02.004.
    1. Schmid D, Kuo HW, Simons E, Kanitz EE, Wenisch J, Allerberger F, et al. All-cause mortality in hospitalized patients with infectious diarrhea: Clostridium difficile versus other enteric pathogens in Austria from 2008 to 2010. J Infect Public Health. 2014;7:133–144. doi: 10.1016/j.jiph.2013.07.010.
    1. Baro E, Galperine T, Denies F, et al. Cost-effectiveness analysis of five competing strategies for the management of multiple recurrent community-onset Clostridium difficile infection in France. PLoS One. 2017;12(1):e0170258. doi: 10.1371/journal.pone.0170258.
    1. Konijeti GG, Sauk J, Shrime MG, Gupta M, Ananthakrishnan AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis. 2014;58(11):1507±14. doi: 10.1093/cid/ciu128.
    1. Bartsch SM, Umscheid CA, Fishman N, Lee BY. Is fidaxomicin worth the cost? An economic analysis. Clin Infect Dis. 2013;57(4):555±61. doi: 10.1093/cid/cit346.
    1. Stranges PM, Hutton DW, Collins CD. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States. Value Health. 2013;16(2):297±304. doi: 10.1016/j.jval.2012.11.004.
    1. Varier RU, Biltaji E, Smith KJ, Roberts MS, Jensen MK, LaFleur J, et al. Cost-effectiveness analysis of treatment strategies for initial Clostridium difficile infection. Clin Microbiol Infect. 2014;20(12):1343±51. doi: 10.1111/1469-0691.12805.
    1. Varier RU, Biltaji E, Smith KJ, Roberts MS, Kyle Jensen M, LaFleur J, et al. Cost-effectiveness analysis of fecal microbiota transplantation for recurrent Clostridium difficile infection. Infect Control Hosp Epidemiol. 2015;36(4):438±44. doi: 10.1017/ice.2014.80.
    1. Lapointe-Shaw L, Tran KL, Coyte PC, Hancock-Howard RL, Powis J, Poutanen SM, et al. Cost-Effectiveness analysis of six strategies to treat recurrent Clostridium difficile infection. PloS One. 2016;11(2):e0149521. doi: 10.1371/journal.pone.0149521.
    1. Nathwani D, Cornely OA, Van Engen AK, Odufowora-Sita O, Retsa P, Odeyemi IAO. Cost-effectiveness analysis of fidaxomicin versus vancomycin in Clostridium difficile infection. J Antimicrob Chemother. 2014;69(11):2901±12. doi: 10.1093/jac/dku257.
    1. Zowall H, Brewer C, Deutsch A. Cost-effectiveness of fecal microbiota transplant in treating Clostridium difficile infection in Canada. Value Health. 2014;17(7):A676. doi: 10.1016/j.jval.2014.08.2512.
    1. Kind P, Lafata JE, Matuszewski K, Raisch D. The use of QALYs in clinical and patient decision-making: issues and prospects. Value Health. 2009;12(Suppl 1):S27–S30. doi: 10.1111/j.1524-4733.2009.00519.x.
    1. Whitehead SJ, Ali S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull. 2010;96(1):5–21. doi: 10.1093/bmb/ldq033.
    1. Shabaruddin FH, Chen LC, Elliott RA, Payne K. A systematic review of utility values for chemotherapy-related adverse events. Pharmaco Economics. 2013;31:277–288. doi: 10.1007/s40273-013-0033-x.
    1. Stark RG, Reitmeir P, Leidl R, König HH. Validity, reliability, and responsiveness of the EQ-5D in inflammatory bowel disease in Germany. Inflamm Bowel Dis. 2010;16(1):42–51. doi: 10.1002/ibd.20989.
    1. The EuroQol Group EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Chevalier J, de Pouvourville G. Valuing EQ-5D using time trade-off in France. Eur J Health Econ. 2013;14:57–66. doi: 10.1007/s10198-011-0351-x.
    1. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45:302–307. doi: 10.1086/519265.
    1. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8.
    1. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682. doi: 10.1093/aje/kwq433.
    1. Wilcox MH, Ahir H, Coia JE, Dogson A, Hopkins S, Llewlyn MJ, Settle C, Mclain-Smith S, Marcella SW. Impact of recurrent Clostridium difficile infection: hospitalization and patient quality of life. J Antimicrob Chemother. 2017;72(9):2647–2656. doi: 10.1093/jac/dkx174.
    1. Blome C, Augustin M. Measuring change in quality of life: bias in prospective and retrospective evaluation. Value Health. 2015;18(1):110–115. doi: 10.1016/j.jval.2014.10.007.
    1. Ross W, Derrett S, Hansen P, Langley J. Retrospective evaluation versus population norms for the measurement of baseline health status. Health Qual Life Outcomes. 2012;10:68. doi: 10.1186/1477-7525-10-68.
    1. Garey KW, Aitken SL, Gschwind L, Goddu S, Xie Y, Duff C, Barbut F, Shah DN, DuPont HL. Development and validation of a Clostridium difficile health-related quality of life questionnaire. J Clin Gastroenterol. 2016;50:631–637. doi: 10.1097/MCG.0000000000000473.
    1. Hjortswanga H, TyskbC BJ, Benonic C, Vigrenc L, Kilanderd A, Larssond L, Tahae Y, Ström M. Health-related quality of life is impaired in active collagenous colitis. Dig Liver Dis. 2011;43:102–109. doi: 10.1016/j.dld.2010.06.004.
    1. Horvath G, Farkas K, Hollosi R, Nagy F, Szepes Z, Papp M, Palatka K, Miheller P, Lakatos L, Szamosi T, Nyari T, Wittmann T, Molnar T. Is there any association between impaired health-related quality of life and non-adherence to medical therapy in inflammatory bowel disease? Scand J Gastroenterol. 2012;47:1298–1303. doi: 10.3109/00365521.2012.703233.
    1. Wang YT, Lim HY, Tai D, et al. The impact of Irritable Bowel Syndrome on health-related quality of life: a Singapore perspective. BMC Gastroenterol. 2012;12:104. doi: 10.1186/1471-230X-12-104.
    1. Canavan C, West J, Card T. Change in quality of life for patients with irritable bowel syndrome following referral to a gastroenterologist: a cohort study. PLoS One. 2015;10(10):e0139389. doi: 10.1371/journal.pone.0139389.
    1. National Cancer Institute . NCI thesaurus adverse event (code C41331) Bethesda: NCI; 2011.
    1. Beusterien KM, Davies J, Leach M, Meiklejohn D, Grinspan JL, O'Toole A, Bramham-Jones S. Population preference values for treatment outcomes in chronic lymphocytic leukaemia: a cross-sectional utility study. Health Qual Life Outcomes. 2010;8:50. doi: 10.1186/1477-7525-8-50.
    1. Shiroiwa T, Fukuda T, Tsutani K. Health utility scores of colorectal cancer based on societal preference in Japan. Qual Life Res. 2009;18:1095. doi: 10.1007/s11136-009-9513-z.
    1. Fordham BA, Kerr C, de Freitas HM, et al. Health state utility valuation in radioactive iodine-refractory differentiated thyroid cancer. Patient Prefer Adherence. 2015;9:1561–1572.
    1. Swinburn P, Lloyd A, Nathan P, Choueiri TK, Cella D, Neary MP. Elicitation of health state utilities in metastatic renal cell carcinoma. Curr Med Res Opin. 2010;26(5):1091–1096. doi: 10.1185/03007991003712258.
    1. Lloyd A, Nafees B, Narewska J, Dewilde S, Watkins J. Health state utilities for metastatic breast cancer. Br J Cancer. 2006;95:683–690. doi: 10.1038/sj.bjc.6603326.
    1. Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non-small cell lung cancer. Health Qual Life Outcomes. 2008;6:84. doi: 10.1186/1477-7525-6-84.
    1. Wright DR, Wittenberg E, Swan JS, Miksad RA, Prosser LA. Methods for measuring temporary health states for cost-utility analyses. PharmacoEconomics. 2009;27(9):713–723. doi: 10.2165/11317060-000000000-00000.

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