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Cost burden of Clostridioides difficile infection to the health service: a retrospective cohort study in Scotland

Research output: Contribution to journalArticle

Open Access Status

  • Embargoed (until 24/07/21)


Chris Robertson, Jiafeng Pan, Kim Kavanagh, Ian Ford, Colin McCowan, Marion Bennie, Charis Marwick, Alistair Leanord

School/Research organisations



Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs.


To evaluate the healthcare and economic burden of CDI in hospitalised patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland.


A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalisations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards.


Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalisation, the cost associated with a CDI case was £5126 higher than for controls.


Using routinely collected national data, we demonstrate the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increase the costs of managing patients with CDI compared with matched controls.



Original languageEnglish
JournalJournal of Hospital Infection
VolumeIn press
Early online date24 Jul 2020
Publication statusE-pub ahead of print - 24 Jul 2020

    Research areas

  • Clostridioides (Clostridium) difficle infection, Cost burden, Hospital infection, Community infection, Retrospective cohort

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