Department of Paediatric Infectious Diseases, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Centre for Clinical Infection and Diagnostics Research, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK.
J Antimicrob Chemother. 2018 Oct 1;73(10):2851-2855. doi: 10.1093/jac/dky250.
Accurate and sufficiently detailed data on the economic burden of Clostridium difficile infection (CDI) are lacking. We performed a micro-costing study to determine the health resource utilization of patients with a first episode of CDI (fCDI) and those with a recurrent episode of CDI (rCDI).
Forty-five adult and paediatric inpatients with rCDI were matched by age, sex and date of diagnosis with control patients with fCDI. Total length of hospital stay, length of stay in the ICU and several cost parameters differentiated into fixed and variable components were measured and compared across both groups.
The mean total length of stay for rCDI patients was 33 days (95% CI 19-46) compared with 17 days (95% CI 12-21) for fCDI patients; P = 0.0259. ICU length of stay was also longer for rCDI patients than for fCDI patients (mean 2.5 versus 0.7 days). Mean total variable costs for fCDI and rCDI were £2382 (95% CI 1750-3014) and £4683 (95% CI 3051-6311), respectively; P = 0.009. Mean fixed costs for fCDI and rCDI were £10 328 (95% CI 7555-13 101) and £26 438 (95% CI 16 135-36 742), respectively; P = 0.003. Mean total costs for fCDI and rCDI were £12 710 (95% CI 9652-15 769) and £31 121 (95% CI 19 792-42 447), respectively; P < 0.002.
The healthcare resource use and financial burden attributable to CDI is significant. Most excess cost is driven by additional length of hospital stay. These costs may have been underestimated in previous studies that have not accounted for several difficult-to-measure parameters or have used averaged tariff-based estimates.
目前缺乏关于艰难梭菌感染（CDI）经济负担的准确且足够详细的数据。我们进行了一项微观成本研究，以确定首次发作艰难梭菌感染（fCDI）和再次发作艰难梭菌感染（rCDI）患者的卫生资源利用情况。
通过年龄、性别和诊断日期，对 45 例 rCDI 成年和儿科住院患者与 fCDI 对照患者进行了匹配。测量并比较了两组患者的总住院时间、重症监护病房（ICU）住院时间和几个成本参数，这些参数分为固定和可变两部分。
rCDI 患者的平均总住院时间为 33 天（95%置信区间 19-46），而 fCDI 患者为 17 天（95%置信区间 12-21）；P=0.0259。rCDI 患者的 ICU 住院时间也长于 fCDI 患者（平均 2.5 天对 0.7 天）。fCDI 和 rCDI 的总可变成本分别为 2382 英镑（95%置信区间 1750-3014）和 4683 英镑（95%置信区间 3051-6311）；P=0.009。fCDI 和 rCDI 的固定成本分别为 10328 英镑（95%置信区间 7555-13101）和 26438 英镑（95%置信区间 16135-36742）；P=0.003。fCDI 和 rCDI 的总费用分别为 12710 英镑（95%置信区间 9652-15769）和 31121 英镑（95%置信区间 19792-42447）；P<0.002。
艰难梭菌感染导致的医疗资源使用和经济负担巨大。大部分额外费用是由住院时间延长引起的。这些成本可能在之前的研究中被低估了，因为这些研究没有考虑到一些难以衡量的参数，或者使用了基于平均费用的估计。
