1921. Attributable Inpatient Costs of Hospital-Onset Clostridium difficile Infection: A Nationwide Case–Control Study in Japan

BACKGROUND: Hospital-onset Clostridium difficile infections (CDIs) have a considerable clinical and economic impact on both patients and payers. Quantifying the economic impact of CDIs can guide treatment strategies. However, previous studies have generally focused on acute care hospitals, and few have included cost estimates from nonacute care hospitals such as rehabilitation centres and long-term care facilities. The aim of this study was to quantify the hospital-onset CDI-attributable inpatient costs and length-of-stay durations in all healthcare institutions that provide inpatient care (including acute and nonacute care) in Japan. METHODS: Using national-level insurance claims data, we analyzed patients who had been hospitalized between April 2010 and December 2016. CDI case patients were identified and matched with non-CDI control patients using hospitalization year, treating hospital, age, sex, surgical procedure, comorbidities, and main diagnoses. Using multivariable regression analyses, we estimated the CDI-attributable inpatient costs and length-of-stay durations while adjusting for variations in factors such as age, sex, comorbidities, surgery, prescribed antibiotic, geographic region, and hospitalization year. We also analyzed the CDI-attributable inpatient costs and length-of-stay durations according to hospital type (acute care and rehabilitation/long-term care). RESULTS: The analysis was conducted using 3,768 matched pairs. Overall CDI-attributable inpatient costs and length-of-stay durations were US$3,213 and 11.96 days, respectively. Rehabilitation/long-term care hospitals had substantially higher inpatient costs and longer hospitalizations than acute care hospitals. CONCLUSION: This study quantified the hospital-onset CDI-attributable inpatient costs and hospitalizations in both acute and nonacute care hospitals. The inclusion of nonacute care hospitals provides a more accurate representation of the economic burden of CDIs. DISCLOSURES: All authors: No reported disclosures.