Lim Vanessa W, Tomaru Takeshi, Chua Brandon, Ma Yan, Yanagihara Katsunori
Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, Singapore 609930, Singapore.
Health Economics and Outcomes Research, Nippon Becton Dickinson Company, Ltd., Akasaka Garden City 15-1, Akasaka 4-Chome, Minato-ku, Tokyo 107-0052, Japan.
Diagnostics (Basel). 2023 Apr 18;13(8):1463. doi: 10.3390/diagnostics13081463.
infection (CDI) is a major healthcare-associated infection that leads to a significant health economic burden in Japan. Using a decision tree model, we evaluated the budget impact of adopting a one-step nucleic acid amplification test (NAAT) alone pathway compared to a two-step diagnostic algorithm with glutamate dehydrogenase (GDH) and toxin antigen, followed by NAAT. The analysis was conducted from the government payer's perspective for 100,000 symptomatic, hospitalized adults requiring a CDI diagnostic test. One-way sensitivity analysis was conducted for all data inputs. The NAAT alone strategy costed JPY 225,886,360 (USD 2,424,714) more, but was more effective, resulting in 1749 more patients accurately diagnosed and 91 fewer deaths compared to the two-step algorithm. Additionally, the NAAT alone pathway costed JPY 26,146 (USD 281) less per true positive CDI diagnosed. The total budget impact, and cost per CDI diagnosed was most sensitive to GDH sensitivity in one-way sensitivity analysis, where a lower GDH sensitivity resulted in greater cost savings with the NAAT alone pathway. Findings from this budget impact analysis can guide the adoption of a NAAT alone pathway for CDI diagnosis in Japan.
艰难梭菌感染（CDI）是一种主要的医疗保健相关感染，在日本造成了巨大的健康经济负担。我们使用决策树模型，评估了与采用谷氨酸脱氢酶（GDH）和毒素抗原的两步诊断算法，随后进行核酸扩增试验（NAAT）相比，单独采用一步核酸扩增试验（NAAT）途径的预算影响。该分析是从政府支付方的角度，针对100,000名有症状的住院成年患者进行的，这些患者需要进行CDI诊断测试。对所有数据输入进行了单向敏感性分析。单独采用NAAT策略的成本高出225,886,360日元（2,424,714美元），但更有效，与两步算法相比，准确诊断的患者多1749例，死亡少91例。此外，单独采用NAAT途径每诊断出一例真正的阳性CDI成本降低26,146日元（281美元）。在单向敏感性分析中，总预算影响以及每例CDI诊断成本对GDH敏感性最为敏感，其中较低的GDH敏感性导致单独采用NAAT途径可节省更多成本。这项预算影响分析的结果可为日本采用单独的NAAT途径进行CDI诊断提供指导。
