Cost-Effectiveness Analysis of Four Common Diagnostic Methods for Clostridioides difficile Infection

Abstract

BACKGROUND: No studies have evaluated the costeffectiveness of single and two-step different diagnostic test strategies for Clostridioides difficile infection (CDI), including direct and indirect costs. OBJECTIVE: To evaluate the cost-effectiveness of commonly available diagnostic tests for CDI including nucleic acid amplification testing (NAAT) alone, glutamate dehydrogenase followed by enzyme immunoassay for toxin (GDH/EIA), GDH then NAAT (GDH/NAAT), and NAAT then EIA (NAAT/EIA). DESIGN: Decision tree model from the US societal perspective with inputs derived from the literature. Willingness-to-pay threshold was set at $150,000 per quality-adjusted life year (QALY) gained. To assess the impact of uncertainty in model inputs on the findings, we performed one-way and probabilistic sensitivity analyses. PARTICIPANTS: We conducted the analysis to represent a population aged 65 years old with diarrhea who received a CDI diagnostic test. MAIN MEASURES: Incremental cost-effectiveness ratios (ICER) and incremental net monetary benefits (INMB).

Budget Impact Analysis of Adopting a One-Step Nucleic Acid Amplification Testing (NAAT) Alone Diagnostic Pathway for Clostridioides difficile in Japan Compared to a Two-Step Algorithm with Glutamate Dehydrogenase/Toxin Followed by NAAT

“…Since transmission of CDI and isolation costs of CDI were both modelled [ 8 ], a missed CDI has a greater economic and clinical consequence, such that the NAAT alone pathway may remain the preferred test strategy in a setting with a lower CDI prevalence. Another cost-effectiveness analysis concluded that the NAAT alone pathway was the most cost-effective strategy for CDI diagnosis, at an incremental cost of USD 55,547 per QALY gained versus a GDH/NAAT pathway [ 23 ]. NAAT alone remained cost-effective compared with a two-step GDH/NAAT pathway over a wide range of CDI prevalence modelled (8.2–19.1%) [ 23 ].…”

“…Based on Japanese clinical practice, we modeled that patients with at least three diarrheal bowel movements (Bristol stool grade ≥5) in the preceding 24 h would be tested and treated [ 22 ]. Up to two CDI recurrences were modelled for patients after the initial CDI, similar to a previous study evaluating the cost-effectiveness of CDI diagnostics in the United States [ 23 ]. Since CDI recurrences usually occur ≤60 days after the cure date of the initial CDI episode [ 24 ], the time horizon of this model was one year.…”

“…The sensitivity and specificity of NAAT, GDH, and toxin antigen were derived from a single laboratory analysis of fecal specimens from patients suspected with CDI in Japanese hospitals [ 28 ]. To calculate the positive predictive value and negative predictive value of NAAT alone, and combination of GDH/toxin followed by NAAT, we used the Bayes rules of conditional probabilities [ 23 , 29 ].…”

Efficiency of Diagnostic Testing for Helicobacter pylori Infections—A Systematic Review

“…In this review, nine articles reported a time horizon of one year or shorter. Only three articles used a longer time horizon in order to capture the medical consequences of developing gastric cancer [ 31 ], acute treatment failure [ 43 ] or childhood acute lymphoblastic leukemia [ 44 ]. The reviewed articles did not consider either the relapses or biofilm formation, perhaps due to the short time horizon reported in the majority of the studies.…”

A passive monitoring tool using hospital administrative data enables earlier specific detection of healthcare-acquired infections

“…Earlier detection may lead to reduced infectious periods for patients, as treatment could be administered sooner. A recent study found that the most cost-effective method for diagnosis of C. difficile cost $54,500 per quality-adjusted life year (QALY) [33]. The low costs of using co-presence as a diagnostic tool would likely lead its cost per QALY to be even lower.…”