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Cost consequences for the NHS of using a two-step testing method for the detection of Clostridium difficile with a point of care, polymerase chain reaction test as the first step

Lookup NU author(s): Dr Will Jones, Stephen RiceORCiD, Dr Michael Power, Dr Gregory Maniatopoulos, Dr Jana SuklanORCiD, Fiona Beyer, Professor John SimpsonORCiD, Dr David Price, Dr Joy AllenORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. 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.

Publication metadata

Author(s): Jones WS, Rice S, Power HM, Maniatopoulos G, Suklan J, Beyer F, Wilcox MH, Permain M, Simpson AJ, Price DA, Allen AJ

Publication type: Article

Publication status: Published

Journal: Diagnostics

Year: 2020

Volume: 10

Issue: 10

Online publication date: 14/10/2020

Acceptance date: 09/10/2020

Date deposited: 24/12/2020

ISSN (electronic): 2075-4418

Publisher: MDPI AG


DOI: 10.3390/diagnostics10100819


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