OBJECTIVES: The aim of this study was (1) to assess the epidemiologic profile of CDI in England and Merseyside in the last decade and (2) to estimate the costs associated with CDI episodes through successive seasons (2008-2012) in a large hospital setting (Royal Liverpool & Broadgreen University Hospitals). METHODS: (1) National figures for incidence and CDI-associated deaths were obtained from the Office for National Statistics and the Public Health England. (2) Clinical and epidemiological information was obtained from 397 consecutive CDI and antibiotic-associated diarrhoea (AAD) patients assessed by medical staff and recruited by a prospective study. Costs were obtained through the determination of hospital stay and the most relevant Healthcare-Resource-Group (HRG) recorded for the disease period until their discharge/death. Generalised linear models with gamma distribution were employed for the multivariate analysis.

RESULTS: A CDI epidemic season was evident between 2005 and 2010, reaching its peak during the 2007/2008 season following by an endemic phase (2011/2012 onwards). Between 2009-2013 when national figures became available, Northern and Western regions displayed the highest incidence and death rates. Within Merseyside, Liverpool had the highest incidence of all. Significantly higher incidence rates of CDI were generally correlated with index-of-multiple-deprivation (IMD), which was particularly higher in Merseyside than the national average. Mean costs for cases were significantly higher (£14,424.07) than controls (£3467.25). Pre-test costs and low Albumin levels were statistically significant predictor of CDI costs.

CONCLUSIONS: CDI was indeed associated with increased overall hospitalisation costs. However, the extent to which CDI per se prolongs hospitalisation remains an objective as comorbidities and underlying conditions (denoted by pre-test costs) were the strongest predictors. Further work is being conducted to disentangle the impact of other significant contributing factors, and the use of HRGs will be compared to Patient-Level-Information-and-Costs-System (PLICS) using a replication set of patients.