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Cost Consequences for the NHS of Using a Two-Step Testing Method for the Detection of Clostridium difficile with a Point of Care, Polymerase Chain Reaction Test as the First Step

Authors :
William S. Jones
Stephen Rice
H. Michael Power
Gregory Maniatopoulos
Jana Suklan
Fiona Beyer
Mark H. Wilcox
Michelle Permain
A. John Simpson
D. Ashley Price
A. Joy Allen
Source :
Diagnostics, Vol 10, Iss 10, p 819 (2020)
Publication Year :
2020
Publisher :
MDPI AG, 2020.

Abstract

Clostridium difficile infection (CDI) is a common healthcare-associated infection. Current practice for diagnosing CDI in the Newcastle upon Tyne Hospitals NHS Foundation Trust involves a three-step, laboratory testing strategy using glutamate dehydrogenase (GDH) enzyme immunoassay (EIA), followed by a polymerase chain reaction (PCR) test then a toxin EIA. However, a PCR point of care test (POCT) for the C. difficile tcdB gene for screening suspected CDI cases, may provide a more efficient way of facilitating an equally effective, two-step, testing strategy with a toxin EIA. This study evaluated the cost consequences of changing from the three-step to a two-step testing strategy. A cost-consequences model was developed to compare the costs and consequences of the two strategies. Uncertainties in the model inputs were investigated with one- and two-way sensitivity analysis. The two-step, POCT strategy was estimated to save £283,282 per 1000 hospitalized NHS patients with suspected infectious diarrhea. Sensitivity analysis indicated that the turnaround time for the POCT was the largest driver for cost savings. Providing the POCT has sufficiently high diagnostic accuracy for detecting C. difficile, the two-step, POCT strategy for CDI identification is likely to be cost saving for NHS hospitals with an offsite laboratory.

Details

Language :
English
ISSN :
20754418
Volume :
10
Issue :
10
Database :
Directory of Open Access Journals
Journal :
Diagnostics
Publication Type :
Academic Journal
Accession number :
edsdoj.3a63c571cadd4fd8a4192edbf8597bf9
Document Type :
article
Full Text :
https://doi.org/10.3390/diagnostics10100819