A hospital-level cost-effectiveness analysis model for toxigenic Clostridium difficile detection algorithms. Issue 2 (October 2015)

• Record Type: Journal Article
• Authors: Verhoye, E.; Vandecandelaere, P.; De Beenhouwer, H.; Coppens, G.; Cartuyvels, R.; Van den Abeele, A.; Frans, J.; Laffut, W.; Bilulu Study Group
• Is Part Of: Journal of hospital infection. Volume 91:Issue 2(2015)
• Page Start: 123
• Page End: 128
• Publication Date: 2015-10
• Subjects: Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2015.06.001
• Languages: English
• ISSNs: 0195-6701

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Summary</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Despite thorough analyses of the analytical performance of <italic>Clostridium difficile</italic> tests and test algorithms, the financial impact at hospital level has not been well described. Such a model should take institution-specific variables into account, such as incidence, request behaviour and infection control policies.</p> </sec> <sec> <title id="sectitle0020">Aim</title> <p id="abspara0015">To calculate the total hospital costs of different test algorithms, accounting for days on which infected patients with toxigenic strains were not isolated and therefore posed an infectious risk for new/secondary nosocomial infections.</p> </sec> <sec> <title id="sectitle0025">Methods</title> <p id="abspara0020">A mathematical algorithm was developed to gather the above parameters using data from seven Flemish hospital laboratories (Bilulu Microbiology Study Group) (number of tests, local prevalence and hospital hygiene measures). Measures of sensitivity and specificity for the evaluated tests were taken from the literature. List prices and costs of assays were provided by the manufacturer or the institutions. The calculated cost included reagent costs, personnel costs and the financial burden following due and undue isolations and antibiotic therapies. Five different test algorithms were compared.</p> </sec> <sec> <title id="sectitle0030">Findings and conclusion</title> <p id="abspara0025">A dynamic calculation model was constructed to evaluate the cost:benefit ratio of each algorithm for a set of institution- and time-dependent inputted variables (prevalence, cost fluctuations and test performances), making it possible to choose the most advantageous algorithm for its setting. A two-step test algorithm with concomitant glutamate dehydrogenase and toxin testing, followed by a rapid molecular assay was found to be the most cost-effective algorithm. This enabled resolution of almost all cases on the day of arrival, minimizing the number of unnecessary or missing isolations.</p> </sec> </abstract>