Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study

Abstract

Background Spread of resistant bacteria causes severe morbidity and mortality. Stringent control measures can be expensive and disrupt hospital organization. In the present study, we assessed the effectiveness and cost-effectiveness of control strategies to prevent the spread of Carbapenemase-producing Enterobacterales (CPE) in a general hospital ward (GW). Methods A dynamic, stochastic model simulated the transmission of CPE by the hands of healthcare workers (HCWs) and the environment in a hypothetical 25-bed GW. Input parameters were based on published data; we assumed the prevalence at admission of 0.1%. 12 strategies were compared to the baseline (no control) and combined different prevention and control interventions: targeted or universal screening at admission (TS or US), contact precautions (CP), isolation in a single room, dedicated nursing staff (DNS) for carriers and weekly screening of contact patients (WSC). Time horizon was one year. Outcomes were the number of CPE acquisitions, costs, and incremental cost-effectiveness ratios (ICER). A hospital perspective was adopted to estimate costs, which included laboratory costs, single room, contact precautions, staff time, i.e. infection control nurse and/or dedicated nursing staff, and lost bed-days due to prolonged hospital stay of identified carriers. The model was calibrated on actual datasets. Sensitivity analyses were performed. Results The baseline scenario resulted in 0.93 CPE acquisitions/1000 admissions and costs 32,050 €/1000 admissions. All control strategies increased costs and improved the outcome. The efficiency frontier was represented by: (1) TS with DNS at a 17,407 €/avoided CPE case, (2) TS + DNS + WSC at a 30,700 €/avoided CPE case and (3) US + DNS + WSC at 181,472 €/avoided CPE case. Other strategies were dominated. Sensitivity analyses showed that TS + CP might be cost-effective if CPE carriers are identified upon admission or if the cases have a short hospital stay. However, CP were effective only when high level of compliance with hand hygiene was obtained. Conclusions Targeted screening at admission combined with DNS for identified CPE carriers with or without weekly screening were the most cost-effective options to limit the spread of CPE. These results support current recommendations from several high-income countries.

ClonalTracker: a tool to elucidate dissemination patterns between vancomycin-resistantEnterococcus faeciumisolates

“…The spread of resistant bacteria especially in healthcare settings may cause increased mortality and morbidity and is also associated with increased healthcare costs 32 . One of the most cost-effective measures to minimize the propagation of bacteria is to do targeted screening and epidemiological typing 33 . With the implementation of WGS in hospitals it is nowadays possible to also track isolates and their mobile genetic elements in a timely manner; a key fact to assess the relatedness between patient’s isolates and proof of nosocomial transmission.…”

Colonization and Healthcare-Associated Infection of Carbapenem-Resistant Enterobacteriaceae, Data from Polish Hospital with High Incidence of Carbapenem-Resistant Enterobacteriaceae, Does Active Target Screening Matter?

“…The targeted screening for identified CRE carriers in the studied hospital with or without weekly screening is the most cost-effective option to limit the spread of CRE [ 17 ]. However, despite the planned actions, the morbidity associated with CR Enterobacteriaceae was very high, more than three times higher than the expected value (USA, before the COVID-19 pandemic [ 13 ]).…”

Public Health Centers' Training Session Programs to Develop Programs on Infection Control Practices for Multidrug-Resistant Organisms in Hospitals in Kawaguchi City, Japan

“…The WHO recommends that screening for asymptomatic CRE colonization should be based on patient risk assessment [ 12 ]. Moreover, SC and AS with a history of CPE infection or colonization or foreign hospital stay decreased CPE acquisitions [ 21 ], indicating that hospitals should examine the implementation of AS. We suggest that the absence of TSs on the effect of AS might contribute to TS programs that are not significantly associated with AS being developed.…”

“…We suggest that the absence of TSs on the effect of AS might contribute to TS programs that are not significantly associated with AS being developed. Therefore, the public health authorities and IC specialists need to provide TSs on the effect of AS to the hospitals [ 21 ]. In Japan, the annual cost of AS for 245 cases was approximately 1,400 USD (191,000 yen) [ 22 ].…”

“…The AS of MDROs was impeded by a difficulty in identifying high-risk patients [ 23 ]. The public health authorities and IC specialists need to provide the hospitals with information on specific targets of AS [ 21 ] and guide them to conduct risk assessment on such.…”