To be honest I’m a bit fed up with quoting the £4000 per CDI case that was calculated by Mark Wilcox and colleagues back in 19 0 plonk (1996 to be exact) and so I was quite excited to stumble across a new estimate from Merseyside whilst browsing ‘Value in Health‘, one of my usual reads. Well, possibly not.. although perhaps it should be – and it does support open access.
Nakamura and colleagues presented an abstract at the 18th International Society for Pharmacoeconomics and Outcomes Research (ISPOR) meeting and have calculated the mean extra cost of a patient with CDI to be £10,956.82, although as the authors point out, how much of this is attributable to the extra cost of CDI rather than the multiple co-morbidities that likely contributed to the infection leading to the antibiotic treatment, which led to the CDI continues to elude us. The authors are continuing to work on this and I await their final findings with interest, however for now I’ll settle for £11,000 per case as opposed to the 1996 figure of £4000 (data collected in 1995) and is probably more realistic than just allowing for inflation that has averaged at 2.8% pa, which would have made it £6868. As we know (well all of us apart from the Treasury), health inflation is way ahead of normal financial indicators.
2 thoughts on “Cost of CDI – New estimate, but how accurate?”
Thanks Martin great post. I too am pretty sick of quoting the age-old £4k per case figure, and agree it is likely to be much higher in reality.
This recent JHI review provides a range of estimates published in the literature (with $29k US per case being the top end of the estimate for HA-CDI, which is pretty close to this estimate): http://www.ncbi.nlm.nih.gov/pubmed/24996516
I tend to use the upper and lower range in this review for estimations of the cost-effectiveness of CDI reduction.
As you are well aware, any cost figure for the treatment of any disease is an extrapolation of a compilation of both accurate and inaccurate studies. And the resulting costs fail to look at the total economic impact the CDI has not only on the patient, but on the family, social services and disability payments, loss of productivity, loss of expertise, and on the list goes.
All healthcare acquired infections have both a direct medical costs and direct economic costs. Here is an example of CDI reporting of figures. Note: The “patient” as a person is not addressed:
Unfortunately, CDI is more prevalent than MRSA and more people die from it than other HAIs. Also unfortunately, there is no single method to stop the continues onslaught of CDI. The populace continues to demand antibiotics for viruses and and other ailments not suitable for antibiotics and physicians continue to prescribe them. It is either part of their culture or part of their fear of litigation. Either way, they must become more judicious and targeted in prescribing antibiotics. In the U.S. the use of antibiotics have become so widespread that pharmacies dispense them at no or very little cost which encourages people to demand them. If there was a higher out-of-pocket cost to consumers for antibiotics people would be more selective and more hesitant to require their physicians to prescribe them.
A retorical question: “Why isn’t there more research into new and safer disinfectants to destroy the C. diff. spore? ” Bleach is effective but destructive to the healthcare environment. When will the realization that spores, all spores, can become airborne and are not confined in a CDI patient’s room? When will infection prevention leaders come to the realization that there is a process to processing a patient room and one vital non-negotiable aspect of that process is time. Time for the professionals to process a room.
We have soaring treatment costs for CDI yet administrators want to use the least costly and most destructive chemical solution to disinfect the healthcare environment and reduce the time needed to properly and safely process the environment. Something does not compute. There can be no cost fixed to the value of a human life, any human life. Yet we constantly see the costs of treatment quoted but not the costs to the person.
The patient was a person before they became a patient and being a patient does not remove their personhood or value. They will not always be a patient, but they will always be a person. When we don’t think of people as patients, something amazing happens – we see their value and worth.
So in answer to “The Cost of CDI” my answer is this: Incalculable.