The potential economic value of screening hospital admissions for Clostridium difficile

• Published in: European journal of clinical microbiology & infectious diseases 2012-11, Vol.31 (11), p.3163-3171
• Main Authors: Bartsch, S. M., Curry, S. R., Harrison, L. H., Lee, B. Y.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Asymptomatic; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Carrier State - diagnosis; Child; Child, Preschool; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium Infections - diagnosis; Colonization; Compliance; Cost analysis; Cost control; Costs and Cost Analysis; Diagnostic Tests, Routine - economics; Diagnostic Tests, Routine - methods; Disease transmission; Economics; Epidemiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospitalization; Hospitals; Human bacterial diseases; Humans; Infant; Infection; Infectious diseases; Internal Medicine; Male; Mass Screening - economics; Mass Screening - methods; Medical Microbiology; Medical sciences; Middle Aged; Models, Theoretical; Nosocomial infections; Other diseases. Semiology; Patient admissions; Sensitivity analysis; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Technology adoption; Third party; Young Adult
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1681-z

Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51–85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile . Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53–272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system.