C. diff Infection Raises Hospital Costs by 40% per Case

Treating Clostridium difficile adds about $7,285 in hospital costs per patient, not including readmissions, research finds.

It can be difficult to quantify the exact economic burden of C. diff on hospitals and the health system as a whole. But a recent study puts a dollar amount on the cost of C. diff, that number is not only big, but also likely underestimated.

Published in the November issue of the American Journal of Infection Control, the study found that C. diff-associated diarrhea (CDAD) increases hospital costs by 40% per case and puts those infected at high risk for longer hospital stays and readmissions.

Researchers conducted a retrospective analysis of inpatient hospital data, examining 171,586 eligible discharges from between January 2009 and December 2011 from approximately 500 U.S. hospitals in the Premier Healthcare Database.

The 40% increase in costs per case added up to an average of $7,285 in additional costs. Costs were higher for certain high-risk subgroups of patients.

In addition, compared to patients without C. diff, those infected had an estimated:

• 77% higher chance of being readmitted within 30 days
• 55% longer hospital stay of nearly five days
• 13% higher risk of mortality

According to Glenn Magee, MBA, lead author of the study and principal research scientist, Premier Research Services, Premier, Inc., other studies into the cost of C. diff have been limited in both geography and demographics—and sometimes limited to single hospitals—causing some hospital executives to question whether their own hospital would experience the same cost burden.

But the hospitals in the Premier Healthcare Database are geographically diverse and provide a representative sampling of both teaching and nonteaching hospitals, according to Premier.

"When you have a study that considerers 500 hospitals and estimates these costs, it's a lot more resonant," he said.

In addition, the study's estimates are conservative for the health system as a whole, mainly because they don't factor in the cost of readmissions, and instead, "only considered hospital costs and not physician or treatment costs beyond the index hospitalization," it says.

"The assumption is that a lot of those readmissions are related to treatment for C. diff…the real cost is actually greater than $7,300," says Magee. "The total impact on health systems as a whole is much greater than that."

The study also looked at CDAD-attributable costs for certain high-risk subgroups of patients and found that they're higher, but only slightly, than the costs for the general population. These are patients

• With renal impairment ($8,942)
• With immunocompromised status ($8,692), and
• With concomitant antibiotic exposure ($8,545)

"The surprising thing was that high-risk subgroups had similar results as people who were not high risk," Magee said.

From here, there are many possible takeaways and actions, says Bimal Shah, MD, MBA, service line vice president, Premier Research Services, Premier, Inc. For instance, he says, antimicrobial stewardship programs can work toward more precise treatments and reducing overuse of antibiotics, which often is associated with C. diff infection.

On the research side, Shah says he'd like to see prospective analyses to determine which tools and standard protocols are most effective, as well as to quantify the effect of early identification and treatment on outcomes.

"This is on the radar for everyone," he says. "It's on the top of every [list at every] hospital, hospital administrator and quality person in all of our hospitals."

Magee adds that hospital leaders and other stakeholders within an organization should also work with other nearby facilities, such as skilled-nursing facilities, to monitor and to be proactive about admissions and discharges between and among institutions to ensure optimal care.

"If I were a healthcare executive, I'd want to make sure that my operational leaders were active in this area," Magee says. "Each hospital is going to have their unique challenges. Have we identified those challenges? And what are we doing to meet them?"