Cost Consequences for the NHS of Using a Two-Step Testing Method for the Detection of <i>Clostridium difficile</i> with a Point of Care, Polymerase Chain Reaction Test as the First Step
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
Affiliations
William S. Jones
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
Stephen Rice
Health Economics Group, Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AA , UK
H. Michael Power
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
Gregory Maniatopoulos
Northumbria University, Newcastle upon Tyne, NE1 8QH, UK
Jana Suklan
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
Fiona Beyer
Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne. NE2 4AX, UK
Mark H. Wilcox
Healthcare Associated Infections Research Group, NIHR Leeds In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds LS1 3EX, UK
Michelle Permain
Microbiology and Virology Services, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
A. John Simpson
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
D. Ashley Price
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
A. Joy Allen
NIHR Newcastle In Vitro Diagnostics Co-operative, Room M2.088, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK
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.
