Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals

A Le Monnier; A Duburcq; J-R Zahar; S Corvec; T Guillard; V Cattoir; P-L Woerther; V Fihman; V Lalande; H Jacquier; A Mizrahi; E Farfour; P Morand; G Marcadé; S Coulomb; E Torreton; F Fagnani; F Barbut; GMC Study Group

doi:10.1016/j.jhin.2015.06.017

Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals

J Hosp Infect. 2015 Oct;91(2):117-22. doi: 10.1016/j.jhin.2015.06.017. Epub 2015 Jul 22.

Authors

A Le Monnier¹, A Duburcq², J-R Zahar³, S Corvec⁴, T Guillard⁵, V Cattoir⁶, P-L Woerther⁷, V Fihman⁸, V Lalande⁹, H Jacquier¹⁰, A Mizrahi¹¹, E Farfour¹², P Morand¹³, G Marcadé¹⁴, S Coulomb², E Torreton², F Fagnani², F Barbut¹⁵; GMC Study Group

Collaborators

GMC Study Group:
O Billuart, S Bouam, E Chachaty, M -P Chaillet, D Dakova, R De Mil, J -W Decousser, C Duteil, S Guéant, F Hémery, M -E Juvin, B Lemaire, A Limelette, M Mons, D Nidegger, A Perozziello, H Poupet, J Reboul-Marty, C Segouin, P Taupin

Affiliations

¹ Laboratoire de Microbiologie Clinique, GH Paris Saint-Joseph, Paris, France. Electronic address: [email protected].
² CEMKA-EVAL, Bourg la Reine, France.
³ Laboratoire de Microbiologie-Hygiène, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker-Enfants malades, AP-HP, Paris, France.
⁴ Service de Bactériologie-Hygiène hospitalière, CHU de Nantes, France.
⁵ Laboratoire de bactériologie-virologie-hygiène hospitalière, CHU de Reims, Hôpital Robert Debré, Université de Reims Champagne Ardenne, France.
⁶ Service de Microbiologie, CHU de Caen, Caen, France.
⁷ Laboratoire de Microbiologie, Institut Gustave Roussy, Villejuif, France.
⁸ Unité de Bactériologie-Hygiène, CHU Henri-Mondor, AP-HP, Créteil, France.
⁹ Département de Bactériologie, Hôpitaux Universitaires Est Parisien, Hôpital Saint-Antoine, AP-HP, Paris, France.
¹⁰ Laboratoire de Microbiologie, Groupe Hospitalier Lariboisière Fernand Widal, AP-HP, Paris, France.
¹¹ Laboratoire de Microbiologie Clinique, GH Paris Saint-Joseph, Paris, France.
¹² Laboratoire de Microbiologie, Centre Hospitalier de Versailles, Le Chesnay, France.
¹³ Service de Bactériologie, Université Paris Descartes, Sorbonne Paris Cité, Hôpital Cochin, AP-HP, Paris, France.
¹⁴ Service de Microbiologie-Hygiène, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Louis Mourier, AP-HP, Colombes, France.
¹⁵ Laboratoire Clostridium difficile associé au CNR des bactéries anaérobies, CHU Saint-Antoine, France.

PMID: 26253518
DOI: 10.1016/j.jhin.2015.06.017

Abstract

Background: The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied.

Aim: The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals.

Methods: A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used.

Findings: A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences.

Conclusion: The economic burden of CDI is substantial and directly impacts healthcare systems in France.

Keywords: Case–control study; Clostridium difficile infection; Costs analysis; Recurrence.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Clostridioides difficile / isolation & purification*
Clostridium Infections / economics*
Clostridium Infections / epidemiology
Clostridium Infections / microbiology
Diarrhea / economics*
Diarrhea / epidemiology
Female
France / epidemiology
Hospital Costs*
Humans
Male
Middle Aged
Recurrence
Retrospective Studies
Young Adult