Natasha Nanwa1, Tetyana Kendzerska2, Murray Krahn3, Jeffrey C Kwong4, Nick Daneman5, William Witteman6, Nicole Mittmann7, Suzanne M Cadarette8, Laura Rosella9, Beate Sander10. 1. 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada. 2. 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada [3] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [4] Department of Medicine, University of Toronto, Toronto, Ontario, Canada [5] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [6] University Health Network, Toronto, Ontario, Canada. 4. 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] University Health Network, Toronto, Ontario, Canada [3] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada [4] Public Health Ontario, Toronto, Ontario, Canada [5] Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. 5. 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Department of Medicine, University of Toronto, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 6. CHU de Quebec University, Quebec City, Quebec, Canada. 7. 1] Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada [2] Health Outcomes and PharmacoEconomic Research Centre, Toronto, Ontario, Canada [3] Department of Pharmacology, University of Toronto, Toronto, Ontario, Canada [4] Richard Ivey School of Business, University of Western Ontario, London, Ontario, Canada. 8. 1] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada [2] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 9. 1] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [2] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada [3] Public Health Ontario, Toronto, Ontario, Canada. 10. 1] Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada [2] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada [3] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada [4] Public Health Ontario, Toronto, Ontario, Canada.
Abstract
OBJECTIVES: With Clostridium difficile infection (CDI) on the rise, knowledge of the current economic burden of CDI can inform decisions on interventions related to CDI. We systematically reviewed CDI cost-of-illness (COI) studies. METHODS: We performed literature searches in six databases: MEDLINE, Embase, the Health Technology Assessment Database, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, and EconLit. We also searched gray literature and conducted reference list searches. Two reviewers screened articles independently. One reviewer abstracted data and assessed quality using a modified guideline for economic evaluations. The second reviewer validated the abstraction and assessment. RESULTS: We identified 45 COI studies between 1988 and June 2014. Most (84%) of the studies were from the United States, calculating costs of hospital stays (87%), and focusing on direct costs (100%). Attributable mean CDI costs ranged from $8,911 to $30,049 for hospitalized patients. Few studies stated resource quantification methods (0%), an epidemiological approach (0%), or a justified study perspective (16%) in their cost analyses. In addition, few studies conducted sensitivity analyses (7%). CONCLUSIONS: Forty-five COI studies quantified and confirmed the economic impact of CDI. Costing methods across studies were heterogeneous. Future studies should follow standard COI methodology, expand study perspectives (e.g., patient), and explore populations least studied (e.g., community-acquired CDI).
OBJECTIVES: With Clostridium difficile infection (CDI) on the rise, knowledge of the current economic burden of CDI can inform decisions on interventions related to CDI. We systematically reviewed CDI cost-of-illness (COI) studies. METHODS: We performed literature searches in six databases: MEDLINE, Embase, the Health Technology Assessment Database, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, and EconLit. We also searched gray literature and conducted reference list searches. Two reviewers screened articles independently. One reviewer abstracted data and assessed quality using a modified guideline for economic evaluations. The second reviewer validated the abstraction and assessment. RESULTS: We identified 45 COI studies between 1988 and June 2014. Most (84%) of the studies were from the United States, calculating costs of hospital stays (87%), and focusing on direct costs (100%). Attributable mean CDI costs ranged from $8,911 to $30,049 for hospitalized patients. Few studies stated resource quantification methods (0%), an epidemiological approach (0%), or a justified study perspective (16%) in their cost analyses. In addition, few studies conducted sensitivity analyses (7%). CONCLUSIONS: Forty-five COI studies quantified and confirmed the economic impact of CDI. Costing methods across studies were heterogeneous. Future studies should follow standard COI methodology, expand study perspectives (e.g., patient), and explore populations least studied (e.g., community-acquired CDI).
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