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US costs and outcomes associated with Clostridium difficile infections: a systematic literature review, meta-analysis, and mathematical model


An understanding of the health and economic impact of C. difficile infections (CDI) can inform investments in prevention and treatment interventions.


To estimate the burden of CDI in the US using a meta-analysis and economic model.


We searched PubMed, CINAHL, EMBASE and others for multicenter studies published in the US between 2000-2014 that evaluated CDI outcomes or costs. Studies were included in the economic analysis if they measured post-infection costs, post-infection length of stay (LOS), or propensity score-matched CDI patients to non-CDI controls. We also included studies that evaluated CDI-associated mortality with a control group. We created an economic model using TreeAgePro 2014.


When the 22 studies that evaluated mortality were pooled, CDI was associated with a 2.5-fold increase in mortality compared with other hospitalized patients (pooled RR=2.54; 95% CI: 1.89, 3.40). Only 4 low/moderate quality studies evaluated costs of CDI. The mean CDI-attributable cost of the index hospitalization ranged from $8,426 to $48,500. The mean costs per CDI after discharge were $1,592 for outpatient visits and $14,847 for readmissions. When these values were adjusted to 2013 US dollars and included in the economic model, we found that the mean total cost of a CDI was $32,198 (SD =$9,798). Of the 3 studies that evaluated LOS using propensity matching, the mean CDI-attributable LOS was 12.3 days. When this excess LOS was multiplied by an average cost per day from a private 3rd party payer perspective, CDI cost an average of $56,663 (SD =$19,804).


Pooled estimates from the currently available literature suggest that CDI is associated with large health and economic burdens. However, the majority of available studies were of moderate/low quality and may overestimate the outcomes. Thus, these estimates should be used with caution and higher-quality studies should be completed to guide future economic evaluations of CDI prevention and treatment interventions.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Schweizer, M., Nelson, R., Samore, M. et al. US costs and outcomes associated with Clostridium difficile infections: a systematic literature review, meta-analysis, and mathematical model. Antimicrob Resist Infect Control 4 (Suppl 1), O37 (2015).

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