Cost-effectiveness in Clostridium difficile treatment decision-making

Table 2 Summary of the most relevant economic issues in Clostridium difficile infection

Level	Issues
Patient level	The cost of recurrence of CDI is high
	CDI leads to additional costs: extra diagnostic tests, extra antibiotics and other medication, time spent by nurse and physician on the ward
	The additional circumstances of these seriously ill patients (e.g., not completing primary therapy, thereby complicating cure or improvement of their disease state) due to CDI should be reflected in the CEA
Population level	The rate of person-to-person transmission of C. difficile is a complicating problem with high costs
	The increased length and overall cost of hospitalization with CDI, including the costs of measures to isolate the patient and other clinical measures to prevent person-to-person transmission, as well as the costs of closing and cleaning wards
	The consequences of developing vancomycin-resistant enterococci or other antibiotic induced resistant enterococci are not integrated in standard cost-effectiveness evaluations

CDI: Clostridium difficile infection; CEA: Carcinoembryonic antigen.