Table 2.
Cost of C. difficile Infection–Associated Hospitalization and Treatment From FY2015 to FY2018
| Variable | FY2015 | FY2016 | FY2017 | FY2018 | P Valuea |
|---|---|---|---|---|---|
| Hospitalization | |||||
| Total days ± SD | 905 ± 24 | 428 ± 11 | 596 ± 11 | 332 ± 33 | … |
| Median length of stay, days (IQR) | 17 (12–26) | 10 (8–16) | 14.5 (10–22) | 19 (12–30) | .03 |
| ICU admission, no. (% positive) | 11 (25) | 3 (8.3) | 11 (32.3) | 2 (13.3) | .07 |
| Expenditures b | |||||
| Median hospitalization cost (IQR) | $74,815 ($50,168–115,872) | $34,670 ($25,547–55,655) | $80,854 ($39,232–112,170) | $69,341 ($41,969–171,939) | .001 |
| Total hospitalization cost ±SD | $4,571,374±$164,669 | $1,944,157±$84,420 | $2,780,681±$52,241 | $1,534,190±$144,755 | … |
| Median CDI treatment cost (IQR) | $257 ($123–309) | $184 ($105–285) | $184 ($79–282) | $101 ($50–167) | .03 |
| Total CDI treatment cost ± SD | $10,379 ± $162 | $7,562 ± $122 | $7,158 ± $204 | $1,476 ± $117 | … |
Abbreviations: FY, fiscal year; IQR, interquartile range; SD, standard deviation; ICU, intensive care unit; IVIG, intravenous immunoglobulin; FMT, fecal microbiota transplant; VASDHS, VA San Diego Healthcare System.
The χ2, Fisher exact or Mann-Whitney U tests were used to analyze numeric variables and C. difficile cases identified pre and post diagnostic stewardship intervention (FY2017 vs FY2018). P ≤ .05 was considered to be significant for all statistical tests.
All costs are represented as US dollars. Hospitalization costs (also referred to as C. difficile infection-related costs) were derived from total days or median length of stay and care provided in a general medicine ward or ICU for C. difficile infection and other comorbidities. Treatment costs were derived from current average wholesale prices of medications (vancomycin, metronidazole, and fidaxomicin) and documented durations of therapy. The cost of oral vancomycin was based on the cost per unit volume of intravenous vancomycin rather than the oral pulvule formulation to represent what is commonly used in practice at the VASDHS. The cost of IVIG and FMT used for a single patient in FY2015 and FY2016 respectively were considered outliers and therefore excluded.