Background: Clostridioides difficile infection (CDI) is the most common health care–associated infection in the United States and has serious clinical consequences with limited data on economic impact on US hospitals. The objective of this study was to quantify the cost of hospitalizations, readmissions, and expected reimbursement for each all-cause and CDI-related hospitalization during 12 months of follow-up for patients with CDI diagnosis at index hospitalization.
Methods: A retrospective, longitudinal analysis of hospitalization data from the Premier Healthcare Database (PHD) was performed. Inclusion criteria were hospitalization (index event) with a primary or secondary discharge diagnosis of ICD-10-CM for CDI (A04.7, A04.71, and A04.72) and no CDI-related hospitalization in the prior 12 months. Patients were followed for ≤12 months after index or until in-hospital death. Costs per readmission and reimbursements from the Centers for Medicare and Medicaid Services (CMS) were assessed. Potential impact of readmissions on hospitals per the National Health Safety Network (NHSN) Standardized Infection Ratio, NHSN Facility-wide Inpatient Hospital-onset CDI Outcome Measure, and Hospital-Acquired Conditions were calculated.
Results: The final study sample included 108,329 patients with CDI-related index hospitalization between January 1, 2017, and September 30, 2018. Patients were mostly female (57.4%) and White (78.6%), with a mean age of 66 years at index; therefore, most patients had Medicare coverage (66.4%). Sepsis represented the most common Medicare Severity Diagnosis Related Group (MS-DRG) coding during index hospitalization (22.5%). During the 12-month follow-up, 21% (22,987), 10% (10,395), and 11% (12,096) of patients had 1, 2, or 3+ all-cause rehospitalizations, respectively; of which 45%, 25%, and 18% were CDI-related. Cumulative CDI-related hospital costs for patients with 1, 2, 3, and ≥4 CDI-related hospitalizations were $43,601, $60,996, $78,356, and $110,618, respectively. Based on the PHD analysis, a sample hospital with 94 index CDI-related hospitalizations per year is estimated to have 46 survivors of recurrent hospitalization, each bearing an avoidable revenue loss of $9100 per patient, excluding quality-of-care–related penalties. Recurrent CDI increases the likelihood of several CMS revenue penalties ranging from a 1% to 4% deduction against total annual Medicare fee-for-service (FFS) reimbursement; for the sample hospital with FFS revenue of $137 million, such penalties could result in an additional overall loss of between $1.4 and $5.5 million.
Conclusions: CDI is a recurrent condition that incurs significant clinical and economic burdens. With every hospitalization, the cost of providing care exceeded the expected reimbursement, and additional reimbursement penalties associated with CDI may result in further hospital financial losses.