The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services

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dc.contributor.advisorManns, Braden
dc.contributor.advisorHenderson, Elizabeth Ann
dc.contributor.authorLeal, Jenine Rocha
dc.contributor.committeememberConly, John M.
dc.contributor.committeememberRonksley, Paul Everett
dc.contributor.committeememberLoeb, Mark
dc.contributor.committeememberNoseworthy, Tom W.
dc.date2019-06
dc.date.accessioned2019-05-06T16:07:09Z
dc.date.available2019-05-06T16:07:09Z
dc.date.issued2019-04-30
dc.description.abstractThe clinical and economic burden of hospital-acquired Clostridioides difficile infection (HA-CDI) is significant, however there is uncertainty in the cost-effectiveness of implementing probiotics for the primary prevention of HA-CDI among hospitalized patients prescribed antibiotics. In this thesis we examined the predictors of mortality and length of stay among this patient population in Alberta. We determined the attributable cost of HA-CDI and applied these estimates in a cost-effectiveness analysis of probiotics for the primary prevention of HA-CDI in Alberta from the perspective of a publicly-funded healthcare system. We conducted three studies: a population-based, retrospective cohort study using clinical surveillance, administrative and laboratory databases to determine the predictors of 30-day all-cause and attributable mortality and length of stay; a propensity score-matched study to compare patients with HA-CDI to patients without CDI to determine the attributable cost of HA-CDI in Alberta; and a cost-effectiveness analysis using decision analytic modelling to evaluate the costs and consequences related to probiotic use for the primary prevention of CDI. We found that the incidence and mortality rates of HA-CDI are declining, though the latter was not statistically significant. Advancing age was associated with all outcomes after adjusting for a number of baseline factors. Increased baseline white blood cell counts were associated with a lower risk of mortality. Hospital-acquired CDI total adjusted costs were 27% higher and length of stay was 13% higher than non-cases of CDI. Oral probiotics as a preventive strategy for CDI resulted in a lower risk of CDI and cost-savings. Previous studies on the burden of HA-CDI have been limited in their size and scope. Our first study was the largest population-based cohort study evaluating predictors of mortality; while our second study was the first to use propensity score-matching and a micro-costing approach for the estimation of costs associated with HA-CDI. We were the first to conduct an economic evaluation of probiotics for the primary prevention of CDI. This work will be presented to Alberta Health Services to support the evaluation of probiotics as a preventive strategy against CDI and whether to scale up probiotics to all provincial hospitals.en_US
dc.identifier.citationLeal, J. R. (2019). The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/36475
dc.identifier.urihttp://hdl.handle.net/1880/110299
dc.language.isoengen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.en_US
dc.subjecthospital-acquired Clostridioides difficile infectionen_US
dc.subjectattributable costsen_US
dc.subjecteconomic evaluationen_US
dc.subjectcost-effectiveness analysisen_US
dc.subjecthealthcare epidemiologyen_US
dc.subjectprobioticsen_US
dc.subject.classificationEconomicsen_US
dc.subject.classificationEpidemiologyen_US
dc.subject.classificationPublic Healthen_US
dc.titleThe Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Servicesen_US
dc.typedoctoral thesisen_US
thesis.degree.disciplineMedicine – Community Health Sciencesen_US
thesis.degree.grantorUniversity of Calgaryen_US
thesis.degree.nameDoctor of Philosophy (PhD)en_US
ucalgary.item.requestcopytrue
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