Propensity score–based comparison of outcomes with 3D conformal radiotherapy (3D-CRT) versus intensity-modulated radiation therapy (IMRT) in treatment of esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 66-66
Author(s):  
Steven H. Lin ◽  
Bevan H Myles ◽  
Lu Wang ◽  
Peter F. Thall ◽  
Ara A. Vaporciyan ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Propensity Scores ◽  
Cox Model ◽  
Performance Status ◽  
Potential Bias ◽  
Current Standard ◽  
Radiation Technology ◽  
Esophageal Cancers ◽  
3D Crt

66 Background: Although 3D-CRT is the current standard for treatment of esophageal cancers, IMRT improves dose conformality and reduces radiation exposure to normal tissue. There is no assessment of long term clinical outcomes comparing these two modalities. Methods: Between 1998-2008, 676 patients (3D-CRT=413, IMRT=263) with stage Ib-IVa (AJCC 2002 edition) esophageal cancers were treated with chemoradiation with or without surgery. To correct for potential bias inherent in observational studies, we employed inverse probability of treatment weighted (IPW) methods based on propensity scores. IPW survival plots and IPW log rank tests were used to adjust for potential bias in treatment selection. Treatment probabilities (propensity scores) were estimated using logistic regression. Results: IMRT patients were less likely to receive induction chemotherapy (35.7% vs 46.7%, p<0.01) and had poorer performance status (KPS≤80: 66.5% vs 50.0%, p<0.01). A fitted multivariate IPW-adjusted Cox model showed that overall survival was significantly associated with age (HR 1.10 for 10 years older, p=0.02), KPS (≤70 vs 90-100, HR 1.5, p=0.0002), having surgery (HR 0.56, p<0.0001), lower vs upper esophagus (HR 1.4, p=0.009), stage (3-4a vs 1-2, HR 2.6, p<0.01), and radiation modality (IMRT vs 3D-CRT, HR 0.68, p<0.0001). 3D-CRT patients had a greater risk of dying at 5 years compared to IMRT (72.6% vs 52.9%, p<0.0001) without a difference in cancer-specific mortality (Gray’s test p=0.86), time to local recurrence (p=0.27) or distant metastasis (p=0.13). Cumulative incidence of documented cardiac deaths trended higher in the 3D-CRT group (p=0.16), but most deaths were due to unknown causes (5 year estimate: 13.4% in 3D-CRT vs 4.2% in IMRT, Gray’s test p<0.0001). Analyses using propensity score as a covariate gave very similar results. Conclusions: There was a substantially higher risk of non-cancer related deaths in 3D-CRT versus IMRT. While the true cause of death cannot be determined for many 3D-CRT patients, our results suggest that improvements in radiation technology may improve treatment-related mortality in management of esophageal cancer.

Inverse-probability weighted and propensity score-based analysis of long-term clinical outcomes comparing 3D conformal radiotherapy (3DCRT) with intensity-modulated radiation therapy (IMRT) in the treatment of esophageal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14548-e14548
Author(s):  
Steven H. Lin ◽  
Lu Wang ◽  
Bevan H Myles ◽  
Peter F. Thall ◽  
Wayne Lewis Hofstetter ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Clinical Outcomes ◽  
Propensity Scores ◽  
Cox Model ◽  
Performance Status ◽  
Conformal Radiotherapy ◽  
Rank Test ◽  
Tumor Control ◽  
Inverse Probability

e14548 Background: IMRT has clear dosimetric advantages in the sparing of normal tissues when compared to the more conventional 3DCRT technique for the treatment of esophageal cancer, but there is currently no clinical outcomes evidence to support the use of IMRT. We hypothesized that the theoretical advantages of IMRT should translate to clinical outcomes benefits compared to 3DCRT. Methods: We analyzed a cohort of 676 patients (3DCRT=413, IMRT=263) treated with chemoradiation with or without surgery between 1998-2008. To correct for potential bias inherent in observational studies, we employed inverse probability of treatment weighted (IPW) methods based on propensity scores. Treatment probabilities (propensity scores) were estimated using logistic regression. Results: IMRT patients were less likely to receive induction chemotherapy and had poorer performance status. A fitted multivariate IPW-adjusted Cox model showed that overall survival was significantly associated with age, KPS, having surgery, tumor location, stage, having PET for staging, and radiation modality. Compared to IMRT, 3DCRT patients had a significantly greater risk of dying (72.6% vs 52.9%, IPW log rank test: p<0.0001) and for local-regional recurrence (LRR) (p=0.0038). The improvement in LRR was only apparent in the non-surgically treated patients due to better tumor control in the primary site, but not in the recurrence in regional nodal sites. There was no difference in cancer-specific mortality, distant metastasis, or postoperative deaths between the two groups. An increased cumulative incidence of cardiac deaths was seen in the 3DCRT group (p=0.049), but the cause of most deaths were unknown (5 year estimate: 11.7% in 3DCRT vs 5.4% in IMRT, Gray’s test, p=0.0029). Analyses using propensity score as a covariate gave very similar results. Conclusions: Our results indicate IMRT improves treatment outcomes in the management of esophageal cancer when compared to 3DCRT. These results, while retrospective, support the use of IMRT for the treatment of esophageal cancer.

scholarly journals Anatomical resections are superior to wedge resections for overall survival in patients with Stage 1 typical carcinoids†

2018 ◽  
Vol 55 (2) ◽  
pp. 273-279 ◽  
Author(s):  
Pier Luigi Filosso ◽  
Francesco Guerrera ◽  
Nicola Rosario Falco ◽  
Pascal Thomas ◽  
Mariano Garcia Yuste ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Surgical Procedure ◽  
Propensity Scores ◽  
Cox Model ◽  
Wedge Resection ◽  
Hazard Ratio ◽  
Shared Frailty ◽  
Stage 1 ◽  
The Impact

Abstract OBJECTIVES Typical carcinoids (TCs) are rare, slow-growing neoplasms, usually characterized by satisfactory surgical outcomes. Due to the rarity of TCs, international guidelines for the management of particular clinical presentations currently do not exist. In particular, non-anatomical resections (wedges) are sometimes advocated for Stage 1 TCs because of their indolent behaviour. The aim of this paper was to evaluate the most effective type of surgery for Stage 1 TCs, using the European Society of Thoracic Surgeons retrospective database of the Neuroendocrine Tumors of the Lung Working Group. METHODS We analysed the effect of surgical procedure on the survival of patients with Stage 1 TCs. Overall survival (OS) was calculated from the date of intervention. The cumulative incidence of cause-specific death (tumour- and non-tumour-related) was also estimated. The impact of the surgical procedure (i.e. lobectomy vs segmentectomy vs wedge resection) on survival was investigated using the Cox model with shared frailty (for OS, accounting for the within-centre correlation) and the Fine and Gray model (for cause-specific mortality) using the approach based on the multinomial propensity score. Effects were estimated including in the model the logit-transformed propensity scores of segmentectomy and wedge resection as covariates. RESULTS A total of 876 patients with Stage 1 TCs (569 women, 65%) were included in this study. The median age was 60 years (interquartile range 47–69). At the last follow-up, 66 patients had died: The 5-year OS rate was 94.3% [95% confidence interval (CI) 92.2–95.9]. The 5-year cumulative incidences of tumour- and non-tumour-related deaths were 2.4% (95% CI 1.4–3.9) and 3.9% (95% CI 2.5–5.6%), respectively. The analysis performed using the multinomial propensity score approach confirmed the significantly worse survival of patients treated with a wedge resection compared to those treated with a lobectomy (hazard ratio 2.01, 95% CI 1.09–3.69; P = 0.024). Similar effects of wedge resection are detectable for cause-specific deaths: tumour-related (hazard ratio 2.28, 95% CI 0.86–6.02; P = 0.096) and non-tumour-related (hazard ratio 1.74, 95% CI 0.89–3.40; P = 0.105). CONCLUSIONS In a large cohort of patients, we were able to demonstrate the superiority of anatomical surgical resection in Stage 1 TCs in terms of OS. This result should therefore be considered for future clinical guidelines for the management of TCs.

Effect of technologic advancements in radiotherapy on postoperative pulmonary complications after neoadjuvant chemoradiation in esophageal cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 110-110
Author(s):  
Bevan H. Myles ◽  
Caimiao Wei ◽  
Ritsuko Komaki ◽  
Ara A. Vaporciyan ◽  
Reza J. Mehran ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Cancer Patients ◽  
Pulmonary Complication ◽  
Neoadjuvant Chemoradiation ◽  
Pulmonary Complications ◽  
Complication Rates ◽  
Postoperative Pulmonary Complications ◽  
Radiation Technology ◽  
3D Crt

110 Background: Although 3D conformal radiation therapy (3D-CRT) is currently the de facto standard for the treatment of esophageal cancers, technologies such as Intensity Modulated Radiation Therapy (IMRT) or Proton Beam Therapy (PBT) are increasingly being used, but the evidence for the clinical benefits of these technologies are lacking. We hypothesized that radiation technology influences perioperative complications in esophageal cancer patients treated with neoadjuvant chemoradiation. Methods: We evaluated 423 patients (3D-CRT (n=208, 1998-2008), IMRT (n=165, 2004-2011), and PBT (n=50, 2006-2011)) treated with surgical resection after chemoradiation from 1998-2011 at M. D. Anderson Cancer Center. Postoperative complications (Pulmonary, GI, cardiac, wound healing) were recorded up to 30 days postoperatively. Kruskal-Wallis tests and Chi-square or Fisher’s exact tests assessed associations between continuous and categorical variables and the radiation technology, respectively. Logistic regression model tested the association between treatment technologies and complications adjusting for other significant patient characteristics. Results: While radiation modality was not significantly associated with postoperative GI (leak, ileus, fistula), cardiac (MI, AF, CHF), and wound complications, there was a significant reduction in postoperative pulmonary complications (ARDS, pleural effusion, respiratory insufficiency, pneumonia) for IMRT compared to 3D-CRT (OR 0.46, 95%CI 0.25, 0.83) and PBT compared to 3D-CRT (OR 0.26, 95%CI 0.09, 0.70), but not when IMRT was compared to PBT (OR 1.74, 95%CI 0.66, 4.61) after adjusting for preRT DLCO level. The median length of hospital stay was also significantly different between treatment modalities (12, 10, and 8 days for 3D-CRT, IMRT, and PBT, respectively, p<0.0001). There was no significant association between treatment year with pulmonary complication rates. Conclusions: Radiation technologies such as IMRT and PBT reduced postoperative pulmonary complication rates compared to 3D-CRT in esophageal cancer patients. This result needs to be confirmed in larger prospective studies.

Comparable Outcomes in Secretory (SM) Versus Non-Secretory (NSM) Multiple Myeloma (MM) with Autologous Hematopoietic Stem Cell Transplantation (AuHCT).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 944-944
Author(s):  
Shaji Kumar ◽  
Waleska S. Pérez ◽  
Mei-Jie Zhang ◽  
Christopher N. Bredeson ◽  
Martha Q. Lacy ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clinical Trials ◽  
Propensity Score ◽  
Disease Progression ◽  
Light Chain ◽  
Cox Model ◽  
Performance Status ◽  
P Value ◽  
Matched Pairs ◽  
Hematopoietic Stem

Abstract BACKGROUND: Non-secretory myeloma (NSM), where immunofixation fails to detect a monoclonal protein in serum and/or urine, accounts for <5% of cases of multiple myeloma (MM). The outcome of patients with NSM versus SM undergoing AuHCT has not been evaluated in clinical trials and patients with NSM are often excluded from clinical trials of MM therapy. METHODS: We compared the probabilities of treatment-related mortality (TRM), disease progression, progression-free survival (PFS) and overall survival (OS) after AuHCT for patients with NSM versus SM transplant between 1989 and 2003, reported to the CIBMTR. Immunofixation reports were reviewed to confirm the diagnosis of NSM. 110 patients with NSM were matched to 438 patients with SM using a propensity score (PS) approach. PS were calculated using age at transplant, Durie-Salmon stage at diagnosis, sensitivity to pretransplant therapy, time from diagnosis to transplant and year of transplant. A logistic regression model was fit and a numerical score derived for each case (NSM recipients). Controls (SM) were matched in random order to cases with similar PS. Multivariate Cox proportional hazards regression models were stratified on matched pairs. Recipients who had a planned second transplant (whether they received their 2nd transplant or not) were excluded. RESULTS: The two groups were similar with respect to disease characteristics at diagnosis (bone marrow plasmacytosis, ISS, renal function) and at transplant (performance status,β2-microglobulin, prior therapy and presence of bone disease). Patients with SM were more anemic and had lower serum albumin levels at diagnosis, while those with NSM were more likely to have preceding plasmacytoma and radiation therapy, presumably to the plasmacytoma. 5-year outcomes, with a median follow-up of 66 months (range, 1 – 177) were as follows: Outcome, Probability (95% CI) NSM SM P-value TRM, % 8 (3 – 14) 7 (5 – 10) 0.86 Disease progression, % 65 (55 – 75) 72 (67 – 76) 0.21 PFS, % 27 (18 – 37) 20 (16 – 25) 0.20 OS, % 51 (40 – 67) 43 (38 – 48) 0.22 In multivariate analysis, based on a Cox model stratified on matched pairs and adjusted for covariates not considered in the propensity score, we found no difference in outcome between the NSM and SM groups. The causes of death were similar between the two groups with disease progression accounting for 75% of deaths. CONCLUSION: In this large cohort of patients undergoing AuHCT, we found no difference in the outcome of patients with NSM compared to those with SM. With increasing use of the free light chain assay, the majority of patients with NSM are expected to have detectable light chain abnormalities thus making them oligosecretory rather than truly non-secretory. This group of patients is generally underrepresented in prospective clinical trials of MM. This study establishes that the post transplant outcomes of this subset of patients are not different and suggests that they should not be excluded from clinical trials.

Validating Four Standard Scales in Spiritually Practicing and Nonpracticing Samples Using Propensity Score Matching

2008 ◽  
Vol 24 (3) ◽  
pp. 165-173 ◽  
Author(s):  
Niko Kohls ◽  
Harald Walach
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Repeated Measures ◽  
Propensity Scores ◽  
Total Sample ◽  
Experimental Manipulation ◽  
Brief Symptom Inventory ◽  
Time Interaction ◽  
Social Support Scale ◽  
Lower Test

Validation studies of standard scales in the particular sample that one is studying are essential for accurate conclusions. We investigated the differences in answering patterns of the Brief-Symptom-Inventory (BSI), Transpersonal Trust Scale (TPV), Sense of Coherence Questionnaire (SOC), and a Social Support Scale (F-SoZu) for a matched sample of spiritually practicing (SP) and nonpracticing (NSP) individuals at two measurement points (t1, t2). Applying a sample matching procedure based on propensity scores, we selected two sociodemographically balanced subsamples of N = 120 out of a total sample of N = 431. Employing repeated measures ANOVAs, we found an intersample difference in means only for TPV and an intrasample difference for F-SoZu. Additionally, a group × time interaction effect was found for TPV. While Cronbach’s α was acceptable and comparable for both samples, a significantly lower test-rest-reliability for the BSI was found in the SP sample (rSP = .62; rNSP = .78). Thus, when researching the effects of spiritual practice, one should not only look at differences in means but also consider time stability. We recommend propensity score matching as an alternative for randomization in variables that defy experimental manipulation such as spirituality.

scholarly journals The Effects of Employment on Depression and Life Satisfaction Among Old-Aged Using the DD Method Combined With PSM

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 408-408
Author(s):  
Si Young Song ◽  
Hey Jung Jun ◽  
Sun Ah Lee
Keyword(s):  
Life Satisfaction ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Multiple Regression ◽  
Propensity Scores ◽  
Panel Study ◽  
Double Difference ◽  
Combined Model ◽  
Comparative Group ◽  
Experimental Group

Abstract The purpose of this study is to explore the effect of employment on depression and life satisfaction among old-aged. Using 12th (2017) wave and 13th (2018) wave of Korean Welfare Panel Study (KoWePS), three stages of analyses were conducted. First, through propensity score matching (PSM) method, sample with similar propensity scores was matched between the group that did not work in 12th wave but worked in 13th wave (experimental group, N=180), and the group that did not work in 12th and 13th wave (comparative group, N=180). Second, the matched sample was used to conduct multiple regression analysis with the group dummy variable (experimental group, comparative group) as an independent variable, and depression and life satisfaction as the dependent variables. Third, combined model of propensity score matching (PSM) and double difference (DD) method was conducted to more appropriately derive the net effect of employment. The results of multiple regression after propensity matching showed that employment had a positive effect on reducing depression (B= -1.70, p&lt; .01) and increasing life satisfaction (B= .12, p&lt; .01) in old-aged. Furthermore, in combined model of PSM and DD, life satisfaction was improved when employed compared to non-employed (B= .15, p&lt; .05). The results of this study are meaningful in that the meaning of employment in old-aged is more clearly derived by solving selection bias and endogenous problems. Also, this study may provide reference for establishing welfare policies related to employment among old-aged.

scholarly journals Probiotics use is associated with improved clinical outcomes among hospitalized patients with COVID-19

2021 ◽  
Vol 14 ◽  
pp. 175628482110356
Author(s):  
Lina Zhang ◽  
Huanqin Han ◽  
Xuan Li ◽  
Caozhen Chen ◽  
Xiaobing Xie ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Standard Care ◽  
Cox Model ◽  
Improvement Rate ◽  
Viral Shedding ◽  
Microbial Dysbiosis ◽  
Relationship Of

Background and aims: Currently, there are no definitive therapies for coronavirus disease 2019 (COVID-19). Gut microbial dysbiosis has been proved to be associated with COVID-19 severity and probiotics is an adjunctive therapy for COIVD-19. However, the potential benefit of probiotics in COVID-19 has not been studied. We aimed to assess the relationship of probiotics use with clinical outcomes in patients with COVID-19. Methods: We conducted a propensity-score matched retrospective cohort study of adult patients with COVID-19. Eligible patients received either probiotics plus standard care (probiotics group) or standard care alone (non-probiotics group). The primary outcome was the clinical improvement rate, which was compared among propensity-score matched groups and in the unmatched cohort. Secondary outcomes included the duration of viral shedding, fever, and hospital stay. Results: Among the propensity-score matched groups, probiotics use was related to clinical improvement rates (log-rank p = 0.028). This relationship was driven primarily by a shorter (days) time to clinical improvement [difference, −3 (−4 to −1), p = 0.022], reduction in duration of fever [−1.0 (−2.0 to 0.0), p = 0.025], viral shedding [−3 (−6 to −1), p < 0.001], and hospital stay [−3 (−5 to −1), p = 0.009]. Using the Cox model with time-varying exposure, use of probiotics remained independently related to better clinical improvement rate in the unmatched cohort. Conclusion: Our study suggested that probiotics use was related to improved clinical outcomes in patients with COVID-19. Further studies are required to validate the effect of probiotics in combating the COVID-19 pandemic.

scholarly journals Exceeding Radiation Dose to Volume Parameters for the Proximal Airways with Stereotactic Body Radiation Therapy Is More Likely for Ultracentral Lung Tumors and Associated with Worse Outcome

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3463
Author(s):  
Mark Farrugia ◽  
Sung Jun Ma ◽  
Mark Hennon ◽  
Chukwumere Nwogu ◽  
Elisabeth Dexter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Propensity Score ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Bronchial Tree ◽  
Lung Tumors ◽  
Gender Performance ◽  
Dose Fractionation ◽  
Stereotactic Body Radiation ◽  
History Of

The preferred radiotherapeutic approach for central (CLT) and ultracentral (UCLT) lung tumors is unclear. We assessed the toxicity and outcomes of patients with CLT and UCLT who underwent definitive five-fraction stereotactic body radiation therapy (SBRT). We reviewed the charts of patients with either CLT or UCLT managed with SBRT from June 2010–April 2019. CLT were defined as gross tumor volume (GTV) within 2 cm of either the proximal bronchial tree, trachea, mediastinum, aorta, or spinal cord. UCLT were defined as GTV abutting any of these structures. Propensity score matching was performed for gender, performance status, and history of prior lung cancer. Within this cohort of 83 patients, 43 (51.8%) patients had UCLT. The median patient age was 73.1 years with a median follow up of 29.9 months. The two most common dose fractionation schemes were 5000 cGy (44.6%) and 5500 cGy (42.2%) in five fractions. Multivariate analysis revealed UCLT to be associated with worse overall survival (OS) (HR = 1.9, p = 0.02) but not time to progression (TTP). Using propensity score match pairing, UCLT correlated with reduced non-cancer associated survival (p = 0.049) and OS (p = 0.03), but not TTP. Within the matched cohort, dosimetric study found exceeding a D4cc of 18 Gy to either the proximal bronchus (HR = 3.9, p = 0.007) or trachea (HR = 4.0, p = 0.02) was correlated with worse non-cancer associated survival. In patients undergoing five fraction SBRT, UCLT location was associated with worse non-cancer associated survival and OS, which could be secondary to excessive D4cc dose to the proximal airways.

P82 A PROPENSITY SCORE MATCHED COHORT STUDY TO EVALUATE THE ASSOCIATION OF LYMPH NODE RETRIEVAL WITH LONG-TERM OVERALL SURVIVAL IN PATIENTS WITH ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R van der Werf, Leonie ◽  
Marra, PhD Elske ◽  
S Gisbertz, PhD Suzanne ◽  
P L Wijnhoven, PhD Bas ◽  
I van Berge Henegouwen, PhD Mark
Keyword(s):  
Esophageal Cancer ◽  
Propensity Score ◽  
Neoadjuvant Chemoradiotherapy ◽  
Stage Migration ◽  
Matched Cohort ◽  
Term Survival ◽  
Node Negative ◽  
Pathological Staging ◽  
Lymph Node Retrieval

Abstract Introduction Previous studies evaluating the association of LN yield and survival presented conflicting results and many may be influenced by confounding and stage migration. This study aimed to evaluate whether the quality indicator ‘retrieval of at least 15 lymph nodes (LNs)’ is associated with better long-term survival and more accurate pathological staging in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy and resection. Methods Data of esophageal cancer patients who underwent neoadjuvant chemoradiotherapy and surgery between 2011-2016 was retrieved from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 LNs and ≥15 LNs were compared after propensity score matching based on patient and tumor characteristics. The primary endpoint was 3-year survival. To evaluate the effect of LN yield on the accuracy of pathological staging, pathological N-stage was evaluated and 3-year survival was analyzed in a subgroup of patients node-negative disease. Results In 2260 of 3281 patients (67%) ≥15 LNs were retrieved. In total, 992 patients with ≥15 LNs were matched to 992 patients with <15 LNs. The 3-year survival did not differ between the two groups (57% versus 54%, p=0.28). pN+ was scored in 41% of patients with ≥15 LNs versus 35% of patients with <15 LNs. For node-negative patients, the 3-year survival was significantly better for patients with ≥15 LNs (69% versus 61%, p=0.01). Conclusions In this propensity score matched cohort, 3-year survival was comparable for patients with ≥15 LNs, although increasing nodal yield was associated with more accurate staging. In node-negative patients, 3-year survival was higher for patients with ≥15 LNs.

Attributable Cost of Clostridium difficile Infection in Pediatric Patients

2017 ◽  
Vol 38 (12) ◽  
pp. 1472-1477 ◽  
Author(s):  
Preeti Mehrotra ◽  
Jisun Jang ◽  
Courtney Gidengil ◽  
Thomas J. Sandora
Keyword(s):  
Logistic Regression ◽  
Clostridium Difficile ◽  
Propensity Score ◽  
Regression Model ◽  
Generalized Linear Model ◽  
Logistic Regression Model ◽  
Propensity Scores ◽  
Healthcare Research ◽  
Design And Methods ◽  
Inpatient Database

OBJECTIVESThe attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children.DESIGN AND METHODSWe analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score–matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost.RESULTSWe identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days.CONCLUSIONSClostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost.Infect Control Hosp Epidemiol 2017;38:1472–1477

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