Health economic burden of refractory and recurrent Clostridioides difficile infection in the inpatient setting of the German healthcare system – the IBIS Study

BACKGROUND: Clostridioides difficile infections (CDIs) remain a prevalent and costly healthcare challenge, particularly affecting elderly, comorbid patients. Evidence on the health economic burden of CDI in Germany, particularly in refractory and recurrent patients is limited. METHODS: The IBIS study was a non-interventional retrospective and prospective study conducted from August 2017 to September 2020 in 10 German hospitals to assess the health economic burden of inpatient CDI treatment. It categorized CDI episodes into initial, refractory and recurrent, following the current ESCMID guidelines. A micro-costing approach from the societal perspective was applied, considering personnel, material, and infrastructure costs for treatment on different types of hospital wards, targeted antibiotic CDI therapies, and productivity losses due to illness-related disability. FINDINGS: Mean total costs per patient were €13,607 (95% CI: €12,124-€15,171) for the initial, €19,953 (95% CI: €16,839-€23,377) refractory and €22,671 (95% CI: €16,088-€30,474; P<0.001) for the recurrence group. Treatment on a general ward was the most important cost driver. Mean hospital length of stay in the initial, refractory group and recurrence group was 30 (95% CI: 27-33) vs 41 (95% CI: 35-46) vs 47 days (95% CI: 37-57; P<0.001), respectively. Patients with initial, refractory and recurrent CDI required 11 (95% CI: 10-1), 15 (95% CI: 13-16) and 24 days (95% CI: 22-27; P<0.001) of targeted antibiotic therapy for CDI. CONCLUSION: The IBIS study contributes valuable insights to the health economic burden of refractory and recurrent CDI in the German inpatient setting and underlines the importance of effective first-line treatment to improve treatment outcomes and reduce overall costs related to CDI.