Increasing hospital costs for Clostridium difficile colitis: Type of hospital matters

Background: To assess differences in hospital costs for inpatients with Clostridium difficile (CD) colitis based on hospital size, rural or urban hospital setting, and hospital designation as a teaching institution. Methods: Data from the Pennsylvania Health Care Cost Containment Council (PHC4) were reviewed for 2005 to 2008. Cost-to-charge ratios were used to derive costs from hospital charges, adjusting costs for inflation. Propensity score-matched CD colitis and non-CD colitis cohorts were compared. Costs were modeled by generalized linear regression. Results: A total of 78,273 patients with CD colitis were identified. The average hospital cost per admission for patients with CD colitis was $22,094 compared to $10,865 for non-CD colitis patients. The 2005 to 2008 admission costs for CD colitis rose 9%, while the prevalence of CD colitis decreased by 13%. The costs for patients with CD colitis were consistently twice as much as those for non-CD colitis patients (P <.0001). Small facilities had the greatest costs overall (P <.0001). Urban and teaching facilities had greater costs than rural and nonteaching facilities (P <.0001), which corresponded to a greater proportion of patients with greater comorbidities (P <.0001). Among rural hospitals, the smallest facilities had the greatest costs (P <.0001), as did urban nonteaching hospitals (P <.0001). By contrast, costs did not differ among urban teaching hospitals of varying sizes (P =.35). Conclusion: Costs for inpatient CD colitis in Pennsylvania have been increasing. Teaching and urban hospitals treat the group of patients with CD colitis with the greatest comorbidity, accounting for their greater cost of care. The cost of treating CD colitis is comparable among different sizes of teaching hospitals, which may reflect a more standardized approach toward treatment choices.