Hospital-acquired Clostridium difficile infection: an institutional costing analysis

Area of Science:

• Healthcare Economics
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Healthcare-acquired Clostridium difficile infection (HA-CDI) represents a significant financial burden within healthcare systems.
• Accurate cost estimation of HA-CDI is crucial for resource allocation and intervention planning.

Purpose of the Study:

• To compare the financial costs of HA-CDI using time-fixed versus time-varying statistical models.
• To assess the impact of accounting for the time interval between admission, HA-CDI diagnosis, and discharge on cost attribution.

Main Methods:

• A retrospective cohort study analyzed clinical and administrative costing data from inpatients admitted to The Ottawa Hospital (April 2008 - March 2011).
• Two time-fixed (OLS, GLM) and two time-dependent (Kaplan-Meier) analyses were employed to compare cost estimation methodologies.

Main Results:

• Time-fixed models estimated HA-CDI costs as high as $74,928 per patient, while time-varying models estimated costs at $28,089 per patient.
• Annual institutional costs for HA-CDI ranged from $10.07 million (time-fixed) to $1.62 million (time-varying) at The Ottawa Hospital.
• The incremental cost per HA-CDI patient was $8,997, 1.47-fold higher than non-infected patients.

Conclusions:

• Incorporating the time between admission, diagnosis, and discharge into cost calculations substantially reduces the estimated institutional costs of HA-CDI.
• Time-varying models provide a more accurate financial assessment of HA-CDI compared to traditional time-fixed approaches.