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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

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 b...

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Autores principales: Jones, William S., Rice, Stephen, Power, H. Michael, Maniatopoulos, Gregory, Suklan, Jana, Beyer, Fiona, Wilcox, Mark H., Permain, Michelle, Simpson, A. John, Price, D. Ashley, Allen, A. Joy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602277/
https://www.ncbi.nlm.nih.gov/pubmed/33066456
http://dx.doi.org/10.3390/diagnostics10100819
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author Jones, William S.
Rice, Stephen
Power, H. Michael
Maniatopoulos, Gregory
Suklan, Jana
Beyer, Fiona
Wilcox, Mark H.
Permain, Michelle
Simpson, A. John
Price, D. Ashley
Allen, A. Joy
author_facet Jones, William S.
Rice, Stephen
Power, H. Michael
Maniatopoulos, Gregory
Suklan, Jana
Beyer, Fiona
Wilcox, Mark H.
Permain, Michelle
Simpson, A. John
Price, D. Ashley
Allen, A. Joy
author_sort Jones, William S.
collection PubMed
description 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.
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spelling pubmed-76022772020-11-01 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 Jones, William S. Rice, Stephen Power, H. Michael Maniatopoulos, Gregory Suklan, Jana Beyer, Fiona Wilcox, Mark H. Permain, Michelle Simpson, A. John Price, D. Ashley Allen, A. Joy Diagnostics (Basel) Article 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. MDPI 2020-10-14 /pmc/articles/PMC7602277/ /pubmed/33066456 http://dx.doi.org/10.3390/diagnostics10100819 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jones, William S.
Rice, Stephen
Power, H. Michael
Maniatopoulos, Gregory
Suklan, Jana
Beyer, Fiona
Wilcox, Mark H.
Permain, Michelle
Simpson, A. John
Price, D. Ashley
Allen, A. Joy
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602277/
https://www.ncbi.nlm.nih.gov/pubmed/33066456
http://dx.doi.org/10.3390/diagnostics10100819
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