Faculty Collaboration Database

Clinical and economic impact of the introduction of a nucleic acid amplification assay for Clostridium difficile. Ann Clin Microbiol Antimicrob 2017 Dec 04;16(1):77

Date

12/06/2017

Pubmed ID

29202797

Pubmed Central ID

PMC5713042

DOI

10.1186/s12941-017-0252-7

Scopus ID

2-s2.0-85037343720 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: The clinical outcomes and cost implications of a diagnostic shift from an EIA- to PCR-based assay for Clostridium difficile infection (CDI) have not been completely described in the literature.

METHODS: The impact of the PCR-based assay on the incidence and duration of CDI therapy was compared to the EIA assay for patients with a negative CDI diagnostic result. Secondary clinical and economic outcomes were also evaluated. Independent predictors of receipt of antibiotic therapy were assessed via logistic regression.

RESULTS: 141 EIA and 140 PCR patients were included. Significantly more patients were started or continued on anti-CDI antibiotic therapy after a known negative assay result in the EIA group (26 patients vs. 8 patients, P = 0.002). Duration of antibiotic therapy after a known negative result was significantly shorter in the PCR group (1 vs. 4 days, P = 0.029) and a 23% reduction in the number of tests obtained per patient was observed (1.41 ± 0.86 vs. 1.82 ± 1.35, P = 0.007). The over fourfold difference in per-test cost of the EIA assay ($8.33 vs. $42.86, P < 0.0001) was offset by the overall medication costs required for the increased treatment in the EIA group ($546.60 vs. $188.96, P = 0.191). Utilization of the EIA-based CDI assay was associated with increased odds of CDI treatment after a negative test (aOR 4.71, 95% CI 1.93-11.46, P = 0.001).

CONCLUSION: The transition from an EIA to PCR-based assay for diagnosing CDI resulted in a significant decrease in the number of patients treated and the duration of treatment in response to a negative test result. This significant decrease in treatment resulted in decreased costs offsetting the utilization of a more expensive molecular test for patients with a negative CDI diagnostic result.

Author List

Guinta MM, Bunnell K, Harrington A, Bleasdale S, Danziger L, Wenzler E

Author

Kristen B. Bresnehan PharmD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anti-Bacterial Agents
Clostridium Infections
Cohort Studies
Costs and Cost Analysis
Diagnostic Tests, Routine
Female
Hospitals
Humans
Illinois
Immunoenzyme Techniques
Logistic Models
Male
Middle Aged
Molecular Diagnostic Techniques
Polymerase Chain Reaction
Retrospective Studies