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Laboratory Testing Strategies for Hospital-Associated Clostridium difficile Infection: An Economic Evaluation.
J Clin Microbiol. 2013 Nov 27;
Authors: Schroeder LF, Robilotti E, Peterson LR, Banaei N, Dowdy DW
Abstract
Clostridium difficile infection (CDI) is the most common cause of infectious diarrhea in the healthcare setting, and presumptive patient isolation while awaiting laboratory results is costly. Newer rapid tests for CDI may reduce this burden, but the economic consequences of different testing algorithms remain unexplored. We used decision analysis from the hospital perspective to compare eight CDI testing algorithms for adult inpatients with suspected CDI, assuming treatment according to lab results. CDI testing strategies included combinations of on demand polymerase chain reaction (odPCR), batch PCR, lateral-flow diagnostics, plate-reader enzyme immunoassay, and direct tissue culture cytotoxicity. In the reference scenario, algorithms incorporating rapid testing were cost-effective relative to non-rapid algorithms. For every 10,000 symptomatic adults (relative to a strategy of treating nobody), lateral-flow GDH/odPCR generated 831 additional true-positive results and cost $1,600 per true-positive case treated. Stand-alone odPCR was more effective and more expensive, identifying 174 additional true-positive cases at $6,900 per case treated. All other strategies were dominated (i.e., more costly and less effective) compared to odPCR, either stand-alone or preceded by lateral-flow screening. Cost-benefit analysis (including cost savings from averted missed cases) favored stand-alone odPCR in many settings, but favored screening with lateral-flow diagnostics if a missed CDI case resulted in less than $5,000 of extended hospital stay costs and under 2 transmissions, if lateral-flow diagnostic sensitivity was over 93%, or if the symptomatic carrier proportion among toxigenic culture-positive cases was over 80%. These results can aid guideline developers and laboratory directors considering rapid testing algorithms for diagnosing CDI.
PMID: 24285740 [PubMed - as supplied by publisher]