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

Area of Science:

• Medical Diagnostics
• Health Economics
• Infectious Diseases

Background:

• Clostridioides difficile infection (CDI) diagnosis is complex due to varied commercial tests and lack of optimal algorithms.
• Existing cost-impact studies for CDI often overlook the unique economic constraints in developing countries.

Purpose of the Study:

• To evaluate and compare the cost of illness for various CDI diagnostic strategies in developing countries.
• To identify the most economically viable and effective CDI diagnostic algorithm for resource-limited settings.

Main Methods:

• A cost-comparison analysis of eleven CDI diagnostic algorithms using a hypothetical cohort of 1000 inpatients.
• Evaluation of turnaround time, test performance (sensitivity, specificity), and direct testing costs.
• Inclusion of additional medical costs: hygiene, medication, length of stay, and ICU care, based on Brazilian hospital data.

Main Results:

• The simultaneous glutamate dehydrogenase (GDH) and toxin A/B rapid immunoassay, arbitrated by nucleic acid amplification test (NAAT), showed the lowest cost of illness ($450,038.70 USD).
• Standalone NAAT was more expensive ($523,709.55 USD), while empirical diagnosis incurred the highest overall cost ($809,605.44 USD).

Conclusions:

• A two-step diagnostic strategy combining GDH/toxin A/B immunoassay with NAAT arbitration is the most cost-effective for CDI diagnosis in developing nations.
• This algorithm offers a practical and economical solution for managing CDI in resource-limited healthcare environments.