title: Cost and Impact on Patient Length of Stay of Rapid Molecular Testing for Clostridium difficile.
abstract: BACKGROUND
  A study was performed to assess the cost of a rapid molecular assay (PCR) for diagnosis of Clostridium difficile infection (CDI) and the impact of its routine use on patient length of stay (LOS) in comparison with cell culture cytotoxin neutralization assay (CCNA).
  
  
  METHODS
  From March 2011 to September 2011, Xpert(®) C. difficile (Cepheid, Sunnyvale, CA, USA) PCR was used on patients with suspicion of CDI in two acute care hospitals in Abertawe Bro Morgannwg University Health Board, Swansea, Wales, UK. Test results were used for patient management. LOS and time to reportable result were compared for negative and positive prospective patients tested by PCR and historic control patients tested by CCNA during March 2010 to September 2010. Tests were priced using micro-costing and a cost comparison analysis was undertaken.
  
  
  RESULTS
  In total, 506 patients were included. Time to reportable result for PCR samples was 1.53 h compared to 46.54 h for CCNA negatives and 22.45 h for CCNA positives. Patients tested by CCNA stayed 4.88 days longer in hospital compared to PCR patients if they tested positive and 7.03 days if tests were negative. The mean reduction in LOS observed in our study has the potential to generate cost savings of up to £2,292.62 for every patient with suspected CDI, if samples were to be tested routinely with PCR instead of CCNA.
  
  
  CONCLUSIONS
  A rapid molecular test for C. difficile in an acute hospital setting produced quick results that led to a decrease in LOS compared to historic CCNA control patients. This could result in considerable savings through reduced excess inpatient days.
authors.affiliation: Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, UK. b.diethart@swansea.ac.uk.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Sewell
authors.affiliation: Public Health Wales, Microbiology ABMUHB, Singleton Hospital, Swansea, UK.
authors.forename: Eugene
authors.initials: E
authors.lastname: Rees
authors.affiliation: Public Health Wales, Microbiology ABMUHB, Singleton Hospital, Swansea, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Thomas
authors.affiliation: Gastroenterology Department, Singleton Hospital, Swansea, UK.
authors.forename: Chin Lye
authors.initials: CL
authors.lastname: Ch'ng
authors.affiliation: Public Health Wales, Microbiology ABMUHB, Singleton Hospital, Swansea, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Isaac
authors.affiliation: Public Health Wales, Microbiology ABMUHB, Singleton Hospital, Swansea, UK.
authors.forename: Nidhika
authors.initials: N
authors.lastname: Berry
keywords: Cell culture cytotoxin neutralization assay; Clostridium difficile; Cost comparison; Length of hospital stay; Polymerase chain reaction (PCR); Rapid molecular testing; Xpert PCR