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Lim VW, Tomaru T, Chua B, Ma Y, Yanagihara K. Budget Impact Analysis of Adopting a One-Step Nucleic Acid Amplification Testing (NAAT) Alone Diagnostic Pathway for Clostridioides difficile in Japan Compared to a Two-Step Algorithm with Glutamate Dehydrogenase/Toxin Followed by NAAT. Diagnostics (Basel) 2023; 13:diagnostics13081463. [PMID: 37189564 DOI: 10.3390/diagnostics13081463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
Clostridioides difficile 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.
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Affiliation(s)
- Vanessa W Lim
- Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, Singapore 609930, Singapore
| | - Takeshi Tomaru
- Health Economics and Outcomes Research, Nippon Becton Dickinson Company, Ltd., Akasaka Garden City 15-1, Akasaka 4-Chome, Minato-ku, Tokyo 107-0052, Japan
| | - Brandon Chua
- Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, Singapore 609930, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-02, Singapore 117549, Singapore
| | - Yan Ma
- Health Economics and Outcomes Research, Becton Dickinson Holdings Pte. Ltd., 2 International Business Park Road, Singapore 609930, Singapore
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University Hospital, Sakamoto 1-12-4, Nagasaki City 852-8523, Japan
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Son KJ, Kim YA, Park YS. Economic Burden Attributable to Clostridioides difficile Infections in South Korea: A Nationwide Propensity Score-Matched Study. J Hosp Infect 2021; 120:1-8. [PMID: 34774670 DOI: 10.1016/j.jhin.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Clostridioides (Clostridium) difficile is an important pathogen that causes diarrhoea in patients who take antibacterial drugs. Considering the limited medical resources, it is necessary to prioritize the management of threats caused by antibiotic use and the spread of germs, but there are little available data, especially for C. difficile infections in South Korea. AIMS In this study, we analysed the hospital length of stay (LOS) and the increase in medical costs due to C. difficile infections. METHODS Propensity score-matched experimental (hospitalized patients with C. difficile infection)-control (hospitalized patients without C. difficile infection) studies were conducted to estimate the increase in the LOS and medical costs associated with C. difficile infections. The data were obtained from the National Health Insurance Service-National Sample Cohort from 2006 to 2015. Reliable results were obtained by actively calibrating various confounding variables of demographic characteristics, disease severity, and information on healthcare facilities. FINDINGS The C. difficile-attributable increase in LOS and hospitalization costs were 36.9 days and 8,298 USD, respectively, per infection case. CONCLUSION This study quantified the considerable burden associated with C. difficile infections in South Korea.
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Affiliation(s)
- K J Son
- Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Korea; Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Y A Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Y S Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea; Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea.
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[SIMULATION ANALYSIS ON COST-EFFECTIVENESS OF SANITARY AND MEDICAL MATERIAL USAGE AT URINARY TRACT INFECTION OUTBREAK CAUSED BY ANTIBIOTIC-RESISTANT BACTERIA IN UROLOGICAL WARD]. Nihon Hinyokika Gakkai Zasshi 2020; 111:63-67. [PMID: 34305090 DOI: 10.5980/jpnjurol.111.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Purpose) The purpose of this study is to compare the costs of active surveillance culture (ASC) and of an environmental cleaner and disinfectant, with the medical costs for inhibiting hospitalized urinary tract infection (UTI) outbreaks in a urology ward over a 3 year 8 months period by simulation calculation. (Methods) We previously reported a UTI outbreak via antibiotic resistant bacteria transmission in 9 hospitalized patients, for which we initiated ASC and introduced a potassium peroxymonosulfate-based product (RUBYSTA® (RST)) as a disinfectant environmental cleaner, then prevented recurrence for 3 years and 8 months. This study compared the actual costs of ASC and RST use to the calculated medical expense for an outbreak leading to urosepsis on the same scale caused by transmission of antibiotic resistant bacteria. (Results) Based on our simulation calculation, ASC and disinfectant costs were about 770,000 Japanese yen lower than the medical expense of resolving an outbreak without recurrence for a period of 3 years and 8 months, based on our direct clinical experience. (Conclusion) Even though it is needless to say that education for medical stuffs, patients and their families is the most important as to the measures for prevention of infections, our simulation study suggests that ASC and RST use may reduce medical costs for resolving such outbreaks and preventing their recurrence for an extended period of time.
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Cost-effectiveness analysis of fidaxomicin for the treatment of Clostridioides (Clostridium) difficile infection in Japan. J Infect Chemother 2020; 26:611-618. [DOI: 10.1016/j.jiac.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/15/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
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Kimura T, Stanhope S, Sugitani T. Clostridioides (Clostridium) difficile infection in Japanese hospitals 2008-2017: A real-world nationwide analysis of treatment pattern, incidence and testing density. J Infect Chemother 2020; 26:438-443. [PMID: 32081648 DOI: 10.1016/j.jiac.2019.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/30/2019] [Accepted: 11/09/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To characterize treatment pattern, incidence and diagnosis of hospital-onset Clostridioides difficile infection (CDI) in Japan, cases were studied over a 9-year period using a large, administrative database. METHODS This was a retrospective, cross-sectional analysis of inpatients at 320 Japanese Diagnosis-Procedure Combination (DPC) hospitals. Hospitalizations between April 2008 and March 2017 were extracted for patients aged ≥18 years. CDI was defined as CDI treatment plus CDI diagnosis or positive enzyme immunoassay (EIA) result. Endpoints included treatment (type, route, daily dose, duration), time to CDI onset from admission, and time to recurrence (rCDI) from the end of treatment. Chronological changes were reported for treatment pattern, CDI incidence and EIA testing. RESULTS The analysis included 11,823 CDI hospitalizations, 1359 with rCDI. Overall, oral metronidazole (MNZ), oral vancomycin (VCM), and intravenous MNZ were used in 50.2%, 42.1% and 1.2% of CDI hospitalizations, respectively. From 2009 to 2017, CDI hospitalizations treated with MNZ more than doubled and VCM more than halved. Median (Q1-Q3) time to CDI and rCDI onset was 25 (11-52) days and 10 (6-17.5) days, respectively. Median treatment duration ranged from 8 to 10 days and median dose was 1 g/day for both MNZ and VCM. CDI incidence remained steady from 2010 until 2017 (0.99/10,000 patient-days) and EIA testing density doubled from 2008 to 2017 (24.46/10,000 patient-days). CONCLUSION Oral MNZ has become the primary CDI treatment in Japanese DPC hospitals. The treatment duration and dose were aligned to the package insert. CDI diagnostic testing density increased over time, CDI incidence did not. CLINICAL TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tomomi Kimura
- Astellas Pharma Inc., 2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Stephen Stanhope
- Astellas Pharma US LLC, 1 Astellas Way, Northbrook, IL, 60062, USA.
| | - Toshifumi Sugitani
- Astellas Pharma Inc., 2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
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Kimura T, Stanhope S, Sugitani T. Excess length of hospital stay, mortality and cost attributable to Clostridioides ( Clostridium) difficile infection and recurrence: a nationwide analysis in Japan. Epidemiol Infect 2020; 148:e65. [PMID: 32115019 PMCID: PMC7118723 DOI: 10.1017/s0950268820000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/19/2019] [Accepted: 02/26/2020] [Indexed: 12/19/2022] Open
Abstract
Clostridioides (Clostridium) difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients, representing a substantial economic burden driven mainly by increased length of hospital stay (LoS). Currently in Japan, limited evidence on CDI-associated excess LoS is available. We conducted a retrospective, matched-cohort study using a large, Japanese, hospital-based administrative database. CDI was defined as CDI treatment plus either CDI diagnosis or positive enzyme immunoassay result. Propensity score matching at the time of CDI or recurrent CDI (rCDI) onset was applied to adjust baseline confounding and immortal time bias. The analysis included 5 994 054 hospitalisation records during 2008-2017, of which 11 823 were identified as CDI and 1359 as rCDI. The median excess LoS attributable to CDI and rCDI was 3 days and 6.5 days, respectively. The excess mortality attributable to CDI was 6.9%; there was no excess mortality attributable to rCDI (-1.9%). The median difference in costs attributable to CDI and rCDI during the residual stay was JPY 130 296 (USD 1185) and JPY 81 054 (USD 737) per hospitalisation, respectively. By adjusting the biases, the burden of CDI in Japan was evaluated. The findings could support decision making and resource allocation for CDI management in Japanese hospitals.
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Hirose N, Ishimaru M, Morita K, Yasunaga H. A review of studies using the Japanese National Database of Health Insurance Claims and Specific Health Checkups. ACTA ACUST UNITED AC 2020. [DOI: 10.37737/ace.2.1_13] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Naoki Hirose
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Takeda S, Miki T. [Antimicrobial profile and clinical evidence of fidaxomicin (Dafclir ®), a therapeutic agent for Clostridioides (Clostridium) difficile infection]. Nihon Yakurigaku Zasshi 2019; 154:217-229. [PMID: 31597902 DOI: 10.1254/fpj.154.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fidaxomicin (Dafclir® Tablets 200 mg) is a member of a novel class of oral, 18-membered macrocyclic antibiotic agents used for the treatment of patients with Clostridioides (Clostridium) difficile (C. difficile) infection (CDI), approved in Japan in July 2018. Preclinical studies demonstrated that fidaxomicin inhibits RNA synthesis by bacterial DNA-dependent RNA polymerase derived from C. difficile, shows antibacterial activities against C. difficile clinically isolated in Japan, and is bactericidal against C. difficile. Fidaxomicin was less likely to disrupt gut microflora due to its narrow antimicrobial spectrum, showing antibacterial activities against limited gram-positive bacteria including C. difficile, but not against gram-negative bacteria, as determined by minimum inhibitory concentration (MIC) measurement against American Type Culture Collection strains. Fidaxomicin inhibited spore production, subsequent spore recovery/outgrowth after removal of fidaxomicin, outgrowth to vegetative cells, and toxin production under fidaxomicin at lower MIC. Additionally, it had protective effects on lethal CDI in animal models. In clinical studies conducted in Europe, US, and Japan, fidaxomicin 200 mg twice daily for 10 days showed higher clinical cure, higher global cure (cure with no recurrence), and lower recurrence rate compared with oral vancomycin 125 mg four times daily for 10 days. Adverse events observed in the fidaxomicin group were similar to those in the vancomycin group, and no clinically important findings regarding safety and tolerability were reported. In conclusion, in vitro, in vivo and clinical evidence indicate that fidaxomicin is an effective treatment for C. difficile, with limited disruption to gut microflora, for adult patients with CDI in Japan.
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Affiliation(s)
- Shinobu Takeda
- Candidate Discovery Science Labs, Drug Discovery Research, Astellas Pharma Inc
| | - Takashi Miki
- Japan-Asia Clinical Development II, Development, Astellas Pharma Inc
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Efficacy of prolonged tapered and pulsed vancomycin regimen on recurrent Clostridioides difficile infection in the Japanese setting: a case control study. J Pharm Health Care Sci 2019; 5:19. [PMID: 31410293 PMCID: PMC6686363 DOI: 10.1186/s40780-019-0147-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/08/2019] [Indexed: 02/04/2023] Open
Abstract
Background According to the Clinical Practice Guidelines for Clostridioides difficile, oral vancomycin is to be used in vancomycin tapered and pulsed regimen (VCM-TP) for recurrent Clostridium difficile infection (CDI). However, data on the efficacy of VCM-TP in Japanese patients with recurrent CDI are scarce. To address this gap, we investigated the efficacy of VCM-TP and performed a case-controlled study to assess the risk factors associated with treatment failure in these patients. Findings We conducted this study on all patients who were administered VCM-TP for recurrent episodes of CDI between January 2008 and December 2018 at Tosei General Hospital. All patients had documented follow-ups within 90 days after completion of the VCM-TP. Data were obtained for comparative analysis of treatment success or failure. Thirty-six patients were eligible for this study, and treatment success was documented in 23 patients (63.9%) following VCM-TP treatment. Treatment success was documented in 22 of 30 (73.3%) patients who received the recommended therapy according to the Clinical Practice Guidelines. The frequency of patients treated with the recommended therapy was higher in the treatment success group (95.7%) than in the treatment failure group (61.5%) (OR: 13.75, 95% CI: 1.39–136.39, p = 0.016). Vancomycin-resistant enterococci culture tests were performed in 20 patients (55.6%), and all results were negative. Conclusions Our findings suggest that VCM-TP is a good therapeutic option for recurrent CDI in Japanese patients. Furthermore, administration of the recommended VCM-TP is important for achieving a high rate of treatment success. Hence, antimicrobial stewardship teams should support the implementation of recommended VCM-TPs.
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Kimura T, Snijder R, Sugitani T. Characterization and risk factors for recurrence of Clostridioides (Clostridium) difficile infection in Japan: A nationwide real-world analysis using a large hospital-based administrative dataset. J Infect Chemother 2019; 25:615-620. [PMID: 30987950 DOI: 10.1016/j.jiac.2019.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/15/2019] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Recurrent Clostridioides (Clostridium) difficile infection (rCDI) is common and increases healthcare resource utilization. In this study, we assessed rCDI risk factors using an up-to-date, Japanese national hospital-based database. METHODS C. difficile infection (CDI) episodes, occurring July 2014-June 2017, in patients aged ≥18 years were extracted from the database and a nested case-control analysis was performed. Cases were defined as rCDI episodes which required re-initiation of oral vancomycin or oral/intravenous metronidazole treatment within 8 weeks from the start of initial treatment. Cases were matched to 4 non-rCDI episodes at the timing of rCDI occurrence. Adjusted odds ratios (ORs) were estimated using multivariate conditional logistic regression model. RESULTS Of 18,246 initial CDI episodes, 3250 (17.8%) had at least one rCDI. Approximately 90% of episodes occurred in inpatients and 65% were treated with metronidazole. Older age (<75 years vs 75-84 years and vs 85 + years) was associated with higher risk of rCDI (OR = 1.27, 95% confidence interval [1.15, 1.41] and 1.45 [1.30, 1.61], respectively). Use of systemic antibiotics (3.16 [2.90, 3.44]), probiotics (2.53 [2.32, 2.77]), chemotherapy (1.28 [1.08, 1.53]), or proton pump inhibitors (PPIs) (1.17 [1.07, 1.28]), and prior CDI history (1.22 [1.03, 1.43]) were also identified as rCDI risk factors. Vancomycin reduced the risk of rCDI compared with metronidazole treatment (0.83 [0.76, 0.91]). CONCLUSION This large, multicenter, nationwide study confirmed that older age, PPIs, antibiotics, probiotics, chemotherapy, and prior CDI history are risk factors for rCDI in Japan. There was a 17% decrease of rCDI risk with vancomycin vs metronidazole treatment. CLINICAL TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tomomi Kimura
- Astellas Pharma Inc., 2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan.
| | - Robert Snijder
- Astellas Pharma, B.V., Sylviusweg 62, 2333 BE, Leiden, the Netherlands
| | - Toshifumi Sugitani
- Astellas Pharma Inc., 2-5-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8411, Japan
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