OBJECTIVES : A previous systematic literature review (SLR) of Clostridioides difficile infection (CDI) global economic burden, conducted up to 2014, showed considerable costs of CDI. This SLR summarizes CDI economic literature published outside of the United States (US) since 2014.

METHODS : An SLR using terms for CDI, costs and/or healthcare resource use was conducted across several databases for publications from 1 January 2014 to 15 August 2018, supplemented by conference and health technology assessment websites searches. Costs attributed to CDI by study authors and differences in regression-adjusted or matched costs between CDI and non-CDI cohorts were extracted. This analysis focuses on cohorts outside the US.

RESULTS : Of 2,342 sources screened, 13 articles met inclusion criteria and reported CDI-attributable cost data outside the US (Canada-2, Europe-8, Australia-2, Japan-1). Most studies reported direct costs only (12/13). Regardless of study methods and adjustments, the costs of CDI groups varied from 1.3 to 5 times the costs of non-CDI groups. Mean CDI-attributable costs per patient reported in Europe ranged from €536 (primary CDI, 1-year cost horizon) to €70,810 (incl. indirect costs of €11,443, recurrent CDI, duration of hospitalization). Canadian studies reported mean CDI-attributable costs from CA$502 (community-onset, 30-day cost horizon) to CA$35,313 (electively hospitalized subject, 3-year cost horizon), which were 1.3-3.2 times the costs of non-CDI patients. In Australia, mean CDI-attributable costs per subject were AUS$11,361 (primary CDI) and AUS$12,603 (secondary CDI) during hospitalization, 2.4–4 times the cost of non-CDI patients. The study in Japan found $3,214 mean incremental costs per inpatient CDI case.

CONCLUSIONS : Recent studies demonstrate high CDI-attributable costs outside of the US, focusing almost exclusively on direct medical costs. Further research is warranted to assess the economic burden of CDI in other non-US countries and to understand the indirect costs of CDI.