On 2014 Aug 16, M P M Hensgens commented:

Dear Peter English, It is indeed correct that we did not study the cost effectiveness of increased testing for C. difficile. In this manuscript we showed that C. difficile occurs in a fair amount in general practitioners practice, although many still consider the disease as nosocomial. Now that we know that the bacterium occurs in this setting, a study concerning the cost effectiveness is an aim for future reseach. Thank you for your interest and kind regards, Marjolein Hensgens

On 2014 Aug 15, Peter English commented:

I didn't spot anything about the costs and benefits of dramatically increasing the amount of testing that this paper is recommending.

If you do a lot more tests for C diff infection, the costs to laboratories and health systems of doing the tests and acting on the results will be considerable. Most health systems have limited resources: money spent on this will have to be taken from something else. That might be worth while; but to be sure, we have to know if the value of doing this (in terms of e.g. reduced years of life lost, QALYs, reduced costs of treatment, reduced sickness/carers' absenteeism and resulting lost revenues etc.) are sufficient to justify the additional costs.

Perhaps I missed this in the paper; but I don't think this was done.

On 2014 Aug 15, Peter English commented:

I didn't spot anything about the costs and benefits of dramatically increasing the amount of testing that this paper is recommending.

If you do a lot more tests for C diff infection, the costs to laboratories and health systems of doing the tests and acting on the results will be considerable. Most health systems have limited resources: money spent on this will have to be taken from something else. That might be worth while; but to be sure, we have to know if the value of doing this (in terms of e.g. reduced years of life lost, QALYs, reduced costs of treatment, reduced sickness/carers' absenteeism and resulting lost revenues etc.) are sufficient to justify the additional costs.

Perhaps I missed this in the paper; but I don't think this was done.

On 2014 Aug 16, M P M Hensgens commented:

Dear Peter English, It is indeed correct that we did not study the cost effectiveness of increased testing for C. difficile. In this manuscript we showed that C. difficile occurs in a fair amount in general practitioners practice, although many still consider the disease as nosocomial. Now that we know that the bacterium occurs in this setting, a study concerning the cost effectiveness is an aim for future reseach. Thank you for your interest and kind regards, Marjolein Hensgens