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Table 1 Net Economic Benefits Model for CDI Prevention: Model Inputs (2015 $)

From: Assessing the social cost and benefits of a national requirement establishing antibiotic stewardship programs to prevent Clostridioides difficile infection in US hospitals

Incidence Rates [28]

HCA-CDI rate per 100,000 persons

Recurrence Rate Per 100,000 persons

Death Rate Per 100,000 persons

Age Group

 1–17

6.3

0.4

NA

 18–44

18.3

3.0

NA

 45–64

83.1

10.9

5.4

 ≥ 65

481.5

117.6

55.1

Effectiveness of the Multifaceted CDI Intervention [27]

10 and 50%

% of Total Deaths Due to CDI [28, 33]

35 and 50%

Cost Inputs [27]

Cost Per Hospital Discharge

Infection Control and Isolation Costs

$3.56 (50 effectiveness), –6.41 (10% effectiveness)

Implementation of the Antimicrobial Use (AU) module

 Initial Cost (in 2015)

$0.08

 Ongoing Costs

$0.03

Antibiotic Stewardship Personnela

 (1.2 Pharmacists +0.67 Infectious Disease Physician + 0.05 Network Data Analysis) × 0.25

$20.58

Federal Government Investment

 Initial Cost (2009–2014)

$0.18

 Ongoing Costs (2015)

$0.03

Cost of Enhanced Cleaning

$0.28

Total

 Initial cost (2015)

  50% program effectiveness

$24.68

  10% program effectiveness

$27.52

 On-going cost (2016–2020)

  50% program effectiveness

$24.47

  10% program effectiveness

$27.32

Benefits of Prevention

 Attributable Patient Cost Savings

  HCA-CDI [27]

$ 6844 (Per Prevented Case)

  Recurrent CDI [27]

$12,703 (Per Prevented Case)

 Length Of Hospital Stay (LOS)b

  Mild/Moderate HCA-CDI Disease

9.5 days

  Recurrent Disease

8.8 days

 QALY/ adjusted to QALD by LOSc

  Mild/Moderate HCA-CDI Disease

0.80 / 0.005205479

  Recurrent Disease

0.708 / 0.00704

  1. HCA-CDI healthcare-associated Clostridioides difficile infection, CDI Clostridioides difficile infection, QALY quality-adjusted life year, QALD quality adjusted life day, LOS length of hospital stay, AU the Antimicrobial Use Option of the Antimicrobial Use and Resistance (AUR) module of the National Healthcare Safety Network (NHSN)
  2. aOnly 25% of total stewardship program and federal government investment costs were attributed to CDI prevention activities as these prevention efforts also involve other multi-drug resistant organisms
  3. bLength of stay for mild/moderate HCA-CDI comes from Gabriel and Beriot-Mathiot while length of stay for recurrent CDI comes from McFarland et al. [37, 44]
  4. cFrom Sullivan et al. the QALY weight selected for mild/moderate HCA-CDI disease is the 25th percentile EQ-5D index score which reflects a population that is older, with more comorbidities, and with a lower socio-demographic profile of respondents in the Medical Expenditure Panel Survey (MEPS) survey [42]. The QALY weight for recurrent HCA-CDI disease corresponds to the 25th percentile EQ-5D score for those older MEPS respondents with “Other Gastrointestinal Disorders” (clinical classification category 155). These weights are adjusted by the LOS associated with HCA-CDI and recurrent CDI disease to reflect the short term, acute nature of mild/moderate CDI disease (See the appendix for the adjustment formula to convert QALY to QALD).