Pfizer Inc, Collegeville, Pennsylvania, USA.
Pfizer Inc, New York, New York, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e1476-e1483. doi: 10.1093/cid/ciac467.
US attributable Clostridioides difficile infection (CDI) mortality and cost data are primarily from Medicare fee-for-service populations, and little is known about Medicare Advantage Enrollees (MAEs). This study evaluated CDI incidence among MAEs from 2012 to 2019 and determined attributable mortality and costs by comparing MAEs with and without CDI occurring in 2018.
This retrospective cohort study assessed CDI incidence and associated mortality and costs for eligible MAEs ≥65 years of age using the de-identified Optum Clinformatics Data Mart database (Optum; Eden Prairie, Minnesota, USA). Outcomes included mortality, healthcare utilization, and costs, which were assessed via a propensity score-matched cohort using 2018 as the index year. Outcome analyses were stratified by infection acquisition and hospitalization status.
From 2012 to 2019, overall annual CDI incidence declined from 609 to 442 per 100 000 person-years. Although the incidence of healthcare-associated CDI declined overall (2012, 53.2%; 2019, 47.2%), community-associated CDI increased (2012, 46.8%; 2019, 52.8%). The 1-year attributable mortality was 7.9% (CDI cases, 26.3%; non-CDI controls, 18.4%). At the 2-month follow-up, CDI-associated excess mean total healthcare and out-of-pocket costs were $13 476 and $396, respectively. Total excess mean healthcare costs were greater among hospitalized (healthcare-associated, $28 762; community-associated, $28 330) than nonhospitalized CDI patients ($5704 and $2320, respectively), whereas total excess mean out-of-pocket cost was highest among community-associated hospitalized CDI patients ($970).
CDI represents an important public health burden in the MAE population. Preventive strategies and treatments are needed to improve outcomes and reduce costs for healthcare systems and this growing population of older US adults.
美国归因于艰难梭菌感染（CDI）的死亡率和成本数据主要来自医疗保险按服务收费人群，而关于医疗保险优势计划参保人（MAEs）的信息则知之甚少。本研究评估了 2012 年至 2019 年期间 MAEs 中 CDI 的发病率，并通过比较 2018 年发生和未发生 CDI 的 MAEs，确定了归因死亡率和成本。
这项回顾性队列研究使用 Optum 临床信息数据集市数据库（Optum；美国明尼苏达州伊登草原）评估了符合条件的年龄≥65 岁的 MAEs 中 CDI 的发病率以及相关的死亡率和成本。该数据库是通过 2018 年作为索引年的倾向评分匹配队列进行评估的。结果包括死亡率、医疗保健利用率和成本。结果分析按感染获得和住院情况进行分层。
2012 年至 2019 年，总体上每年的 CDI 发病率从每 100000 人年 609 例降至 442 例。尽管总体上医疗保健相关 CDI 的发病率有所下降（2012 年为 53.2%，2019 年为 47.2%），但社区获得性 CDI 的发病率有所上升（2012 年为 46.8%，2019 年为 52.8%）。1 年归因死亡率为 7.9%（CDI 病例为 26.3%，非 CDI 对照为 18.4%）。在 2 个月的随访中，CDI 相关的平均总医疗保健和自付费用分别为 13476 美元和 396 美元。与非住院 CDI 患者相比（医疗保健相关为 5704 美元，社区相关为 2320 美元），住院（医疗保健相关，28762 美元；社区相关，28330 美元）CDI 患者的总超额平均医疗保健费用更高，而社区相关住院 CDI 患者的总超额自付费用最高（970 美元）。
CDI 是 MAE 人群中一个重要的公共卫生负担。需要预防策略和治疗方法来改善医疗保健系统和这个不断增长的美国老年人群的结果并降低成本。
