Table 3.
Use of Comparator Group, Study End Points, and Study Results
| Author | Year | Database | Sample Size (Cases) | Comparator Group Match | Propensity Score Match | Relevant End Points | Results |
|---|---|---|---|---|---|---|---|
| Nelson WW, Scott TA, Boules M, et al 1 | 2021 | Medicare | 268,762 | No | No | Resource use, costs | Mean total all-cause direct costs were $76,024 for no CDI recurrence and $96,517 for at least 3 CDI recurrence episodes. |
| Duhalde L, Lurienne L, Wingen-Heimann SM, et al 17 | 2020 | Truven Health MarketScan | 622 | Yes | No | Hospital LOS, inpatient costs | The average cost for cancer and CDI was $196,524 versus $136,365 for cancer without CDI. The average time in the hospital was 23.1 days longer with CDI. |
| Feuerstadt P, Stong L, Dahdal DN, et al 2 | 2020 | PharMetrics Plus | 46,571 | No | No | Costs | The mean annual total all-cause direct medical costs per CDI patient were $71,980 with no recurrence and $207,733 for those with 3 or more recurrences. |
| Garg SK, Obaitan I, Sarvepalli S, et al 18 | 2020 | Healthcare Cost and Utilization Project Nationwide Emergency Department Sample | 909,236 | No | No | Charges, admission, hospital LOS | There were 909,236 emergency department visits for CDI and 90% were admitted to the hospital. Charges per visit escalated to $2,900. LOS declined to 5.8 days. |
| Hall BR, Armijo PR, Leinicke JA, et al 19 | 2019 | Vizient | 1,059 | No | No | Mortality, hospital LOS, costs | More days from admission to surgery were associated with higher mortality, hospital LOS, infectious complications, and hospital charges. |
| Mollard S, Lurienne L, Heimann SM, et al 20 | 2019 | Truven Health MarketScan | 46,097 | Yes for subset | No | Hospital LOS, inpatient costs | Inpatients with CDI primary diagnosis had mean cost of $10,528 and LOS of 5.9 days. CDI as comorbidity had mean additional cost of $11,938 and added hospital LOS of 4.4 days. |
| Shrestha MP, Bime C, Taleban S 21 | 2018 | Healthcare Cost and Utilization Project national inpatient sample | 587,799 | No | No | Mortality, hospital LOS, costs | Hospital charges for patients with a principal diagnosis of CDI increased from $24,535 in 2004 to $35,898 in 2014. Mortality decreased from 3.6% in 2004 to 1.6% in 2014. |
| Zhang D, Prabhu VS, Marcela SW 3 | 2018 | Truven Health MarketScan | 55,504 | Yes | Yes | Hospital days, healthcare costs | 24.8% of patients had recurrence. Average hospital days for CDI was 8.01 versus 2.81 for matched non-CDI. Average healthcare cost across all patients with primary CDI was $43,718 versus $19,513 for a matched group without CDI. |
| Kulayat AN, Rocourt DV, Podany AB, et al 36 | 2017 | Healthcare Cost and Utilization Project Kids | 1,438 | Yes | Yes | Hospital LOS, inpatient costs | The mean excess hospital LOS and costs attributable to CDI were 5.8 days and $12,801. |
| Kuntz JL, Baker JM, Kipnis P, et al 4 | 2017 | Kaiser Permanente Northern California | 4,174 | Yes | No (used “optimal matching algorithm”) | Health resources | Recurrent CDI patients had substantially higher levels of healthcare utilization than both patients with nonrecurrent CDI and patients that never had CDI. |
| Mehrotra P, Jang J, Gidengil C, et al 22 | 2017 | Healthcare Cost and Utilization Project Kids | 8,527 | Yes | Yes | Hospital LOS, inpatient costs | The attributable cost of CDI ranged from $1,917 to $8,317 and the increase in hospital LOS was 4 days. |
| Rodrigues R, Barber GE, Ananthakrishnan AN 5 | 2017 | Partners Healthcare Network | 98 | No | No | Healthcare utilization, estimated costs | 84% of patients had a CDI hospitalization and total CDI-associated cost was $34,104 per patient. |
| Zilberberg MD, Shorr AF, Jesdale WM, et al 20 | 2017 | Medicare and Minimum Data Set | 14,472 | No | No | Hospital days, healthcare costs | Adjusted excess hospital days per patient was 20.3 and Medicare reimbursements were $12,043 in the group with recurrence. |
| Shah DN, Aitken SL, Barragan LF, et al 7 | 2016 | Single hospital | 540 | No | No | Recurrence, hospital LOS, costs | 18% of primary CDI patients had a recurrence. Total hospital median hospital LOS and costs increased with recurrence. |
| Shorr AF, Zilberberg MD, Wang L, et al 23 | 2016 | Medicare and Medicaid | 6,838 | Yes | Yes | Mortality and costs | CDI was associated with near doubling of both mortality and total healthcare costs. |
| Yu H, Baser O, Wang U 24 | 2016 | Medicare, Medicaid, and Minimum Data Set | 32,807 | Yes | Yes | Incidence, mortality, healthcare costs | Total healthcare costs within 2 months following first CDI episode were significantly higher for CDI residents ($28,621 vs $13,644) for combined Medicare and Medicaid costs. Mortality rates higher in CDI group. |
| Drozd EM, Inocencio TJ, Braithwaite S, et al 25 | 2015 | Medicare | 3,262 | Yes | Yes | Mortality and costs | Patients with CDI have 1.87 times greater odds of inpatient mortality compared to those without CDI. Hospital LOS with CDI was 1.82 times greater than those without CDI. Patients with CDI had 1.16 times greater hospital cost than patients without CDI. |
| Gallagher JC, Reilly JP, Navalkele B, et al 26 | 2015 | Premier | 95 | No | No | 90-day readmission | Recurrence occurred in 20.4% of patients on fidaxomicin and 41.3% on vancomycin. Costs estimated to be $454,800 for vancomycin and $196,200 for fidaxomicin. |
| Magee G, Strauss ME, Thomas SM, et al 27 | 2015 | Premier | 84,225 | Yes | Yes | Hospital LOS, inpatient costs | Hospital LOS and total costs were higher with CDI than non-CDI. |
| Palli SR, Broderick KC, Quimbo RA, et al 28 | 2015 | HealthCore Integrated Research | 500 | No | No | Resource use, costs | Mean cost was $35,621 (SD $100,502). Two-thirds of patients had GI or ID consultation. |
| Dubberke ER, Schaefer E, Reske KA, et al 8 | 2014 | Single hospital | 421 | No | No | Costs | The attributable cost of recurrent CDI was $11,631. |
| Campbell R, Dean B, Nathanson B, et al 29 | 2013 | Cerner | 4,521 | Yes | Yes | Hospital LOS, inpatient costs | Adjusted total hospital LOS was significantly greater with CDI in 4 of 5 subgroups. Total hospital costs were greater with CDI in patients who were aged ≥65 years and those on antibiotics. |
| Quimbo RA, Palli WR, Singer J, et al 30 | 2013 | HealthCore Integrated Research | 21,177 | Yes | No | Hospital LOS, inpatient costs | Incremental hospital LOS and hospitalization cost was increased for CDI across all subgroups compared to matched groups. |
| Sammons JS, Localio R, Xiao R, et al 31 | 2013 | Pediatric Health Information System | 5,107 | Yes | Yes | Mortality, hospital LOS, costs | In-hospital mortality was higher with CDI than matched controls. Also, mean differences in hospital LOS and total cost were higher with both community-acquired and hospital-acquired CDI than matched controls. |
| Tabak YP, Zilberberg MD, Johannes RS, et al 32 | 2013 | CareFusion | 282 | Yes | Yes | Mortality, hospital LOS, costs | CDI patients had higher mortality, longer hospital LOS, and higher costs. |
| Lipp MJ, Nero DC, Callahan MA. 33 | 2012 | New York State Department of Health | 1,913 | No | No | Charges and hospital LOS | Hospital-acquired CDI impacted both charges ($29,000 increase) and hospital LOS (12 additional hospital days). |
| Pakyz A, Carroll NV, Harpe SE, et al 34 | 2011 | University HealthSystem Consortium | 10,857 | Yes | No | Hospital LOS, inpatient costs | Adjusted mean cost for patients with CDI was $55,769 compared to $28,609 for controls. There was also a longer hospital LOS with cases than controls. |
| Stewart DB, Hollenbeak CS 35 | 2011 | Medicare | 41,207 | Yes | Yes | Mortality, hospital LOS, costs | Mean cost of hospitalization, hospital LOS, and mortality were higher with CDI than matched controls. |
Note. CDI, Clostridioides difficile infection; GI, gastrointestinal; ID, infectious disease; LOS, length of stay; NA, not applicable; SD, standard deviation.