Center for Observational and Real-World Evidence, Merck & Co, Inc, Kenilworth, New Jersey.
Clin Infect Dis. 2018 Apr 17;66(9):1326-1332. doi: 10.1093/cid/cix1021.
The economic burden of Clostridium difficile infection (CDI), the leading cause of nosocomial infectious diarrhea, is not well understood. The objective of this study was to estimate the healthcare resource utilization (HCRU) and costs attributable to primary CDI and recurrent CDI (rCDI).
This is a database (MarketScan) study. Patients without CDI were matched 1:1 by propensity score to those with primary CDI but no recurrences to obtain HCRU and costs attributable to primary CDI. Patients with primary CDI but no recurrences were matched 1:1 by propensity score to those with primary CDI plus 1 recurrence in order to obtain HCRU and costs attributable to rCDI. Adjusted estimates for incremental cumulative hospitalized days and healthcare costs over a 6-month follow-up period were obtained by generalized linear models with a Poisson or gamma distribution and a log link. Bootstrapping was used to obtain 95% confidence intervals (CIs).
A total of 55504 eligible CDI patients were identified. Approximately 25% of these CDI patients had rCDI. The cumulative hospitalized days attributable to primary CDI and rCDI over the 6-month follow-up period were 5.20 days (95% CI, 5.01-5.39) and 1.95 days (95% CI, 1.48-2.43), respectively. The healthcare costs attributable to primary CDI and rCDI over the 6-month follow-up period were $24205 (95% CI, $23436-$25013) and $10580 (95% CI, $8849-$12446), respectively.
The HCRU and costs attributable to primary CDI and rCDI are quite substantial. It is necessary to reduce the burden of CDI, especially rCDI.
艰难梭菌感染（CDI）是医院获得性传染性腹泻的主要病因，其经济负担尚未得到充分认识。本研究旨在评估原发性 CDI 和复发性 CDI（rCDI）相关的医疗资源利用（HCRU）和成本。
这是一项基于数据库（MarketScan）的研究。通过倾向评分，将无 CDI 的患者与原发性 CDI 但无复发的患者进行 1:1 匹配，以获得原发性 CDI 相关的 HCRU 和成本。将原发性 CDI 但无复发的患者与原发性 CDI 加 1 次复发的患者进行 1:1 匹配，以获得 rCDI 相关的 HCRU 和成本。通过具有泊松或伽马分布和对数链接的广义线性模型，获得 6 个月随访期间累计住院天数和医疗保健费用的调整估计值。使用 bootstrap 方法获得 95%置信区间（CI）。
共确定了 55504 名符合条件的 CDI 患者。这些 CDI 患者中约有 25%患有 rCDI。在 6 个月的随访期间，原发性 CDI 和 rCDI 归因于住院的累计天数分别为 5.20 天（95%CI，5.01-5.39）和 1.95 天（95%CI，1.48-2.43）。在 6 个月的随访期间，原发性 CDI 和 rCDI 归因于医疗保健的费用分别为 24205 美元（95%CI，23436-25013）和 10580 美元（95%CI，8849-12446）。
原发性 CDI 和 rCDI 相关的 HCRU 和成本相当可观。有必要减轻 CDI 的负担，特别是 rCDI。
