Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis

Abstract

Aims: This study aimed to evaluate all-cause economic outcomes, healthcare resource utilization (HRU), and costs in patients with Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) using commercial claims from a large database representing various healthcare settings.

Materials and methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus database was conducted for patients aged 18–64 years with CDI episodes requiring inpatient stay with CDI diagnosis code or an outpatient medical claim for CDI plus a CDI treatment. Index CDI episodes occurred between 1 January 2010 and 30 June 2017, including only those where patients were observable 6 months before and 12 months after the index episode. Each CDI episode was followed by a 14-d claim-free period. rCDI was defined as another CDI episode within an 8-week window following the claim-free period. HRU, all-cause direct medical costs and time to rCDI were calculated over 12 months and stratified by number of rCDI episodes.

Results: A total of 46,571 patients with index CDI were included. Mean time from one CDI episode to the next was approximately 1 month. In the 12-month follow-up period, those with no recurrence had 1.4 inpatient visits per person and those with 3 or more recurrences had 5.8. Most patients with 3 or more recurrences had 2 or more hospital admissions. The mean annual, total all-cause direct medical costs per patient were $71,980 for those with no recurrence and $207,733 for those with 3 or more recurrences.

Limitations: The study included individuals 18–64 years only. A stringent definition of rCDI was used, which may have underestimated the incidence of rCDI.

Conclusions: CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. Timing of recurrences can be predictable, providing a window of opportunity for interventions. Prevention of multiple rCDI appears essential to reduce healthcare costs.

Keywords:

• Clostridium difficile infection
• Clostridioides difficile infection (CDI)
• recurrent CDI (rCDI)
• real-world outcomes
• healthcare resource utilization
• direct medical costs

JEL CLASSIFICATION CODES:

• I10
• I19

Transparency

Declaration of funding

The study was funded by Ferring Pharmaceuticals Inc. (Parsippany, NJ).

Declaration of financial/other interests

Drs. Stong, Nelson, and Dahdal are employees of Ferring Pharmaceuticals Inc. Dr. Feuerstadt has served as a consultant to and on the speaker’s bureau for Merck and Co, and has served as a consultant for Ferring Pharmaceuticals Inc. and Roche Pharmaceuticals. Drs. Sacks and Lang are employees of Precision Health Economic and Outcomes Research and provided consulting services to Ferring Pharmaceuticals Inc.

A peer reviewer on this manuscript has disclosed that they have received consultancy fees from Astellas Pharma. The peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Acknowledgements

Medical writing and editorial support was provided by Agnella Izzo Matic, PhD, CMPP (AIM Biomedical, LLC) and was funded by Ferring Pharmaceuticals Inc.

Author contributions

LS, WN, DND, NS, and KL designed and conducted the study. All authors analyzed and interpreted the data, drafted and critically revised the article for important intellectual content, and approved the article for publication.

Previous presentations

Portions of the data contained in this manuscript appeared in abstract/poster form at IDWeek 2019, October 2-6, 2019, Poster 2374. This manuscript has not been submitted and is not under consideration for publication anywhere else.