The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services
Bibliographic record
Abstract
The 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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".