Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis
Healthcare resource utilization and direct medical costs associated with index and recurrent Clostridioides difficile infection: a real-world data analysis
复制标题
DOI：
10.1080/13696998.2020.1724117
复制
发表时间：
2020-02-11
影响因子：
2.4
通讯作者：
Nelson, Winnie W.
中科院分区：
文献类型：
--
作者：
Feuerstadt, Paul;Stong, Laura;Nelson, Winnie W.
目的：本研究旨在使用来自代表各种医疗保健环境的大型数据库的商业索赔来评估艰难梭菌感染 (CDI) 和复发性 CDI (rCDI) 患者的全因经济结果、医疗资源利用率 (HRU) 和成本。材料和方法：对来自 IQVIA PharMetrics Plus 数据库的商业索赔数据进行回顾性分析，对象是年龄在 18-64 岁、患有 CDI 发作且需要使用 CDI 诊断代码住院或需要 CDI 加 CDI 治疗的门诊医疗索赔的患者。指数CDI发作发生在2010年1月1日至2017年6月30日之间，仅包括指数发作前6个月和后12个月可观察到的患者。每次 CDI 发作后都有 14 天的免索赔期。 rCDI 被定义为无索赔期后 8 周窗口内的另一次 CDI 发作。 HRU、全因直接医疗费用和 rCDI 时间在 12 个月内进行计算，并根据 rCDI 发作次数进行分层。结果：总共纳入了 46,571 名患有指数 CDI 的患者。从一次 CDI 发作到下一次发作的平均时间约为 1 个月。在12个月的随访期间，没有复发的患者每人住院次数为1.4次，复发3次或以上的患者每人住院次数为5.8次。大多数复发 3 次或以上的患者已入院 2 次或以上。对于没有复发的患者，每位患者的平均年度全因直接医疗费用总额为 71,980 美元，对于有 3 次或以上复发的患者，为 207,733 美元。局限性：该研究仅包括 18-64 岁的个体。使用了严格的 rCDI 定义，这可能低估了 rCDI 的发生率。结论：CDI 和 rCDI 与大量医疗资源利用和直接医疗成本相关。复发的时间是可以预测的，为干预提供了机会之窗。预防多种 rCDI 对于降低医疗成本至关重要。
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.