University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada.
PLoS One. 2019 Nov 8;14(11):e0224609. doi: 10.1371/journal.pone.0224609. eCollection 2019.
Even though the incidence of community-acquired Clostridium difficile infection (CDI) is reported to be increasing, few studies have reported on the healthcare costs of community-acquired CDI. We estimated cost of care for individuals with community-associated CDI and compared with that for matched controls without CDI in the time period of six months before to one year after CDI.
All individuals in the province of Manitoba, diagnosed with CDI between July 2005 and March 2015 were matched up to 4 individuals without CDI. Health care utilization and direct costs resulting from hospitalizations, physician reimbursement claims and prescriptions were determined from the population based provincial databases. Quantile regressions were performed to determine predictors of cost of individuals with community associated CDI.
Of all CDIs, 30-40% in each period of the study had community-associated CDI; of which 12% were recurrent CDIs. The incremental median and 90th percentile cost of care for individuals with community-associated CDI was $800 and $16,000 respectively in the six months after CDI diagnosis. After adjustment for age, co-morbidities, sex, socioeconomic status and magnitude of health care utilization prior to CDI, the median incremental cost for recurrent CDI was $1,812 and that for a subsequent episode of CDI was $3,139 compared to those with a single community-associated CDI episode. The median cost for a prescription of Vancomycin was $316 (IQR 209-489).
Health care costs of an episode of community-associated CDI have been much more than the cost of antibiotic treatment. Our study provides population-based data for formal cost effectiveness analysis for use of newer treatments for community-associated CDI.
尽管社区获得性艰难梭菌感染（CDI）的发病率据报道正在上升，但很少有研究报告社区获得性 CDI 的医疗保健成本。我们估计了与社区相关的 CDI 个体的护理成本，并将其与 CDI 发生前六个月至一年后无 CDI 的匹配对照个体进行了比较。
在 2005 年 7 月至 2015 年 3 月期间，曼尼托巴省所有诊断为 CDI 的个体均与 4 名无 CDI 的个体相匹配。从基于人群的省级数据库中确定了与住院、医生报销索赔和处方相关的医疗保健利用和直接成本。进行分位数回归以确定与社区相关的 CDI 个体成本的预测因素。
在研究的每个时期，所有 CDI 中有 30-40%为社区获得性 CDI；其中 12%为复发性 CDI。在 CDI 诊断后六个月内，与社区相关的 CDI 个体的护理成本中位数和第 90 百分位数分别为 800 美元和 16000 美元。在调整年龄、合并症、性别、社会经济地位和 CDI 前的医疗保健利用程度后，复发性 CDI 的中位增量成本为 1812 美元，随后的 CDI 发作成本为 3139 美元，而单次社区获得性 CDI 发作的成本为 3139 美元。万古霉素处方的中位数费用为 316 美元（IQR 209-489）。
社区获得性 CDI 发作的医疗保健成本远高于抗生素治疗成本。我们的研究为使用新的社区获得性 CDI 治疗方法进行正式的成本效益分析提供了基于人群的数据。
