title: Comparing the economic and health benefits of different approaches to diagnosing Clostridium difficile infection.
abstract: Accurate diagnosis of Clostridium difficile infection (CDI) is essential to effectively managing patients and preventing transmission. Despite the availability of several diagnostic tests, the optimal strategy is debatable and their economic values are unknown. We modified our previously existing C. difficile simulation model to determine the economic value of different CDI diagnostic approaches from the hospital perspective. We evaluated four diagnostic methods for a patient suspected of having CDI: 1) toxin A/B enzyme immunoassay, 2) glutamate dehydrogenase (GDH) antigen/toxin AB combined in one test, 3) nucleic acid amplification test (NAAT), and 4) GDH antigen/toxin AB combination test with NAAT confirmation of indeterminate results. Sensitivity analysis varied the proportion of those tested with clinically significant diarrhoea, the probability of CDI, NAAT cost and CDI treatment delay resulting from a false-negative test, length of stay and diagnostic sensitivity and specificity. The GDH/toxin AB plus NAAT approach leads to the timeliest treatment with the fewest unnecessary treatments given, resulted in the best bed management and generated the lowest cost. The NAAT-alone approach also leads to timely treatment. The GDH/toxin AB diagnostic (without NAAT confirmation) approach resulted in a large number of delayed treatments, but results in the fewest secondary colonisations. Results were robust to the sensitivity analysis. Choosing the right diagnostic approach is a matter of cost and test accuracy. GDH/toxin AB plus NAAT diagnosis led to the timeliest treatment and was the least costly.
authors: Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Sarah M
authors: SM
authors: Bartsch
authors: Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors: Craig A
authors: CA
authors: Umscheid
authors: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors: Irving
authors: I
authors: Nachamkin
authors: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors: Keith
authors: K
authors: Hamilton
authors: Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Obesity Prevention Center (GOPC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: brucelee@jhu.edu.
authors: Bruce Y
authors: BY
authors: Lee
mesh_terms: D000328:Adult; D001431:Bacteriological Techniques / Q000191:economics* / Q000379:methods; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005188:False Negative Reactions; D006801:Humans; D007118:Immunoassay; D008954:Models, Biological; D015233:Models, Statistical
keywords: Clostridium difficile; cost; diagnosis; diagnostic tests; economics