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Attributable costs and length of stay of hospital-acquired Clostridioides difficile: A population-based matched cohort study in Alberta, Canada

Published online by Cambridge University Press:  25 July 2019

Jenine R. Leal Open the ORCID record for Jenine R. Leal [Opens in a new window] ,
John Conly ,
Robert Weaver ,
James Wick ,
Elizabeth A. Henderson ,
Braden Manns  and
Paul Ronksley
Jenine R. Leal
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
John Conly
Affiliation:
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada Department of Pathology, University of Calgary, Calgary, Alberta, Canada Department of Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada Snyder Institute for Chronic Diseases, University of Calgary, Alberta, Canada Alberta Health Services, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary, Alberta, Canada
Robert Weaver
Affiliation:
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
James Wick
Affiliation:
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Elizabeth A. Henderson
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Infection Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
Braden Manns
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Alberta Health Services, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary, Alberta, Canada Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
Paul Ronksley*
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada O’Brien Institute for Public Health, University of Calgary, Alberta, Canada
*
Author for correspondence: Dr Paul Ronksley Email: peronksl@ucalgary.ca
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Abstract

Objective:

To determine the attributable cost and length of stay of hospital-acquired Clostridioides difficile infection (HA-CDI) from the healthcare payer perspective using linked clinical, administrative, and microcosting data.

Design:

A retrospective, population-based, propensity-score–matched cohort study.

Setting:

Acute-care facilities in Alberta, Canada.

Patients:

Admitted adult (≥18 years) patients with incident HA-CDI and without CDI between April 1, 2012, and March 31, 2016.

Methods:

Incident cases of HA-CDI were identified using a clinical surveillance definition. Cases were matched to noncases of CDI (those without a positive C. difficile test or without clinical CDI) on propensity score and exposure time. The outcomes were attributable costs and length of stay of the hospitalization where the CDI was identified. Costs were expressed in 2018 Canadian dollars.

Results:

Of the 2,916 HA-CDI cases at facilities with microcosting data available, 98.4% were matched to 13,024 noncases of CDI. The total adjusted cost among HA-CDI cases was 27% greater than noncases of CDI (ratio, 1.27; 95% confidence interval [CI], 1.21–1.33). The mean attributable cost was $18,386 (CAD 2018; USD $14,190; 95% CI, $14,312–$22,460; USD $11,046-$17,334). The adjusted length of stay among HA-CDI cases was 13% greater than for noncases of CDI (ratio, 1.13; 95% CI, 1.07–1.19), which corresponds to an extra 5.6 days (95% CI, 3.10–8.06) in length of hospital stay per HA-CDI case.

Conclusions:

In this population-based, propensity score matched analysis using microcosting data, HA-CDI was associated with substantial attributable cost.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1135 - 1143
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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