765. The Burden of Illness Associated with Recurrent Clostridioides difficile Infection: A Claims-based Analysis

Background Clostridioides difficile infection (CDI) is a significant public health concern and the leading cause of infection related healthcare utilizations in adults in the United States. A considerable proportion of CDI patients suffer recurrent episodes of CDI (rCDI). The objective of this study was to describe the impact of CDI on healthcare resource utilization (HCRU) and patient burden. Methods A retrospective analysis of patients with a CDI diagnosis claim was conducted using the HealthVerity database. Continuous enrollment with medical and pharmacy benefits was required for 12 months before and after the first occurrence of CDI diagnosis (index date). Patients were stratified by total number of CDI episodes. rCDI episodes were defined as episodes that occurred within 12 weeks of the previous episode. Baseline demographics, treatment by episode, and HCRU data were captured. Results 5,964 patients with a CDI episode were identified. The average age was 56.6 years with 30.2% of the population being ≥ 65 years old. 65.7% of patients were female and 61.2% had a claim for ≥ 1 antibiotic in the 90 days leading up to the index date. Vancomycin was the predominant treatment used across all episodes (54-67%). Use of fecal microbiota transplant (FMT) increased with number of CDI episodes (12.6% for the 3rd episode; 20.7% for 5th episode). Fidaxomicin was used for initial CDI treatment in 7.5% of cases. Prior to the initial CDI episode, 24% of patients had ≥ 1 emergency department (ED) visit, 64% had an outpatient office visit and 49% had an inpatient admission due to any cause. In the post-index period, 73% of patients experienced ≥ 1 ED visits, 95% had an outpatient office visit and 72% were admitted to the hospital for any cause. As the number of CDI episodes increased, the number of ED visits, inpatient admissions and ICU admissions trended upwards. Conclusion Results from this observational analysis suggest that the presence of CDI seems to lead to a considerable increase in HCRU after the initial episode. Despite variation in treatment patterns by episode, some HCRU seems to increase with additional episodes. Disclosures Rachel M. Black, PharmD, Seres Therapeutics (Consultant) Richard Stanford, PharmD, MS, AbbVie (Consultant)Sanofi-Genzyme (Consultant)Seres Therapeutics (Consultant) Dan Gratie, PharmD, MS, Seres Therapeutics (Consultant)