Increasing Economic Burden of Inpatient Clostridium difficile Infection in the United States: National Trends in Epidemiology, Outcomes, and Cost of Care from 2000 to 2014

Abstract

Abstract Background There is limited data addressing the epidemiology, costs, and outcomes of Clostridium difficile infection (CD) in hospitalized patients in the United States (U.S.). This study aims to estimate the characteristics, outcomes, and economic burden of patients hospitalized for CD in the US. Methods The Nationwide Inpatient Sample (NIS) database was used to obtain data from 2000–2014. The NIS contains data from over 7 million hospitalizations in the US per year, generalizable to the American population. The NIS was queried for ICD-9 codes for either a primary or secondary diagnosis of CD (008.45). Information for demographic data, length of stay (LOS), mortality, and hospital charges was evaluated. Results There were 1,256,783 total discharges from 2000–2014 with CD as the primary diagnosis and 4,204,338 total discharges during the same period with CD listed as any diagnosis. The number of hospitalizations with CD as primary diagnosis increased from 31,782 in 2000 to 107,760 in 2014. The number of hospitalizations with CD listed as any diagnosis increased from 134,518 to 361,945. Mean LOS decreased from 6.8 to 5.8 days and mean charges per hospitalization increased from $15,810 to $35,898 during the same time period. Aggregate charges increased from $0.51 billion to $3.87 billion annually. Inpatient mortality of CD hospitalizations decreased from a 4.03% in 2005 to 1.67% in 2014. Approximately 42% of those admitted for CD were male and 58% were female. Conclusion This study demonstrates that the number of hospitalizations for CD has increased by 339% from 2000 to 2014. Inpatient mortality of CD has decreased, likely from earlier recognition and treatment of CD. The direct cost of admissions with CD as primary diagnosis is nearly $4 billion per year. Our findings affirm that CD infection is an epidemic that remains a significant source of morbidity and mortality with substantial hospitalization and cost burden. This data can be used to support a return on investment for intervention strategies to prevent CD transmission and for new therapies. Disclosures All authors: No reported disclosures.