A cost of illness comparison for toxigenic Clostridioides difficile diagnosis algorithms in developing countries

Anaerobe. 2021 Aug:70:102390. doi: 10.1016/j.anaerobe.2021.102390. Epub 2021 May 28.

Abstract

Background: Availability of several commercial tests with different Clostridioides difficile targets contributes to uncertainty and controversies around the optimal diagnostic algorithm. While numerous studies have estimated the financial impact of C. difficile infection, models to guide testing strategies decisions in developing countries, where economic value significantly impacts clinical practice, are currently not available.

Aim: To determine the cost of illness of different C. difficile infection (CDI) diagnostic strategies in developing countries.

Methods: Cost-comparison analysis was performed to compare eleven different algorithms of CDI diagnosis. The basis of calculation was a hypothetical cohort of 1000 adult inpatients suspected of CDI. We analyzed turnaround time of test results (i.e., time from taking sample to results emission), test performance (i.e., sensitivity and specificity) and testing costs. Patients were divided in true positive, false positive, true negative and false negative in order to integrate test performance and economics effects. Additional medical costs were calculated: costs of hygiene, medication, length of stay and intensive care unit costs, based on a Brazilian University Hospital costs. CDI prevalence was considered 22.64%.

Findings: From laboratory-assisted tests, simultaneous glutamate dehydrogenase (GDH) and toxin A/B rapid immunoassay arbitrated by nucleic acid amplification test (NAAT) presented the lowest cost of illness (450,038.70 USD), whereas standalone NAAT had the highest (523,709.55 USD). Empirical diagnosis only presented the highest overall cost (809,605.44 USD).

Conclusion: The two-step algorithm with simultaneous GDH and toxin A/B rapid immunoassay arbitrated by NAAT seems to be the best strategy for CDI diagnosis in developing countries.

Keywords: Clostridioides difficile; Clostridioides difficile infection; Clostridium difficile; Cost of illness analysis; Glutamate dehydrogenase; Nucleic acid amplification test.

Publication types

  • Comparative Study

MeSH terms

  • Algorithms
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / genetics
  • Bacterial Toxins / analysis
  • Brazil
  • Clostridioides difficile / genetics
  • Clostridioides difficile / isolation & purification*
  • Clostridioides difficile / physiology
  • Clostridium Infections / diagnosis*
  • Clostridium Infections / drug therapy
  • Clostridium Infections / economics*
  • Clostridium Infections / microbiology
  • Cost of Illness
  • Developing Countries / economics
  • False Negative Reactions
  • Glutamate Dehydrogenase / genetics
  • Humans
  • Immunoassay / economics*
  • Immunoassay / methods
  • Nucleic Acid Amplification Techniques / economics*
  • Nucleic Acid Amplification Techniques / methods

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • Bacterial Toxins
  • Glutamate Dehydrogenase