Estimating the excess bed days and economic burden of healthcare-associated infections in Singapore public acute-care hospitals

Cai, Yiying; Venkatachalam, Indumathi; Kwa, Andrea Lay Hoon; Tambyah, Paul A.; Hsu, Li Yang; Marimuthu, Kalisvar; Graves, Nicholas

doi:10.1017/ice.2021.165

Cited by 7 publications

(6 citation statements)

References 9 publications

(10 reference statements)

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“…The quality of the data used for the model parameters is good, with the data gathered for the first national prevalence survey [14] utilised for this analysis. The excess length of stay parameters were estimated using a state-based model that appropriately includes the timing of key events of HAI, death and discharge from hospital [20]. A recent review found analyses that use time fixed methods for the estimation of these outcomes generate biased, inflated, outcomes [28].…”

Section: Discussionmentioning

confidence: 99%

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore

et al. 2022

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Objectives To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting. Method We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention. Results We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore. Conclusions We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.

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Section: Discussionmentioning

confidence: 99%

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore

et al. 2022

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“…In the study, patients with CRE and CSE HAIs were indirectly matched for time at risk by matching to a common control group without infection. Estimates for annual CRE HAI incidence were based on studies published by Cai et al [11,12]. Drug doses followed international antibiotic guidelines [13].…”

Section: Data Inputmentioning

confidence: 99%

“…It was previously estimated that the incidence of HAIs among patients admitted in public acute care hospitals in Singapore was 15,980 ± 840 patients per 100,000 inpatient admissions [12]. Based on the Singapore point prevalence survey on HAIs, 151 out of 727 HAIs (20.8%) were attributable to Enterobacterales; of these, 7.0% were non-susceptible to carbapenems (% of CRE HAIs out of all HAIs = 1.5%) [11].…”

Section: Expected Annual Burden Of Cre Haismentioning

confidence: 99%

“…To estimate the annual cost of infections, accurate measurements in the infection incidence and the additional length of stay is important [3,24]. Our estimates for annual burden of CRE HAIs were based on a national point prevalence survey for HAIs [11,12]. The study is the only nationwide HAI prevalence study in Singapore to date and employed rigorous methods for the survey conduct [11].…”

Section: Plos Global Public Healthmentioning

confidence: 99%

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Estimating the economic cost of carbapenem resistant Enterobacterales healthcare associated infections in Singapore acute-care hospitals

Cai

Hoo

Lee

et al. 2022

PLOS Glob Public Health

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Quantifying the costs of hospital associated infections (HAIs) caused by carbapenem-resistant Enterobacterales (CRE) can aid hospital decision makers in infection prevention and control decisions. We estimate the costs of a CRE HAI by infection type and the annual costs of CRE HAIs to acute-care hospitals in Singapore. We used tree diagrams to estimate the costs (in Singapore dollar) of different CRE HAI types from the health service perspective and compared them to the costs of carbapenem-susceptible HAIs. We used two approaches to estimate costs–direct costs of consumables for infection prevention and treatment; and costs associated with lost bed days. Cost of a HAI were extrapolated to annual CRE HAI incidence in Singapore acute-care hospitals to estimate the annual cost to the hospitals. We found that the cost of a CRE HAI based on direct cost and lost bed days are SGD$9,913 (95% CI, SGD$9,431–10,395) and SGD$10,044 (95% CI, SGD$9,789–10,300) respectively. CRE HAIs are markedly higher than the carbapenem-susceptible HAIs for all infection types. In both approaches, CRE pneumonia was the costliest infection. Based on a CRE HAI incidence of 233 per 100,000 inpatient admissions, CRE HAIs costed SGD$12.16M (95% CI, SGD$11.84–12.48M) annually based on direct costs, and SGD$12.33M (95% CI, SGD$12.01–12.64M) annually based on lost bed days. In conclusion, we described the cost of CRE HAIs in Singapore hospitals and identified infections with the highest costs. The findings may be useful in informing future economic evaluations of competing CRE HAI prevention and treatment programmes.

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“…PCNSIs are associated with significantly increased treatment costs, prolonged hospitalization time, psychological trauma, and delayed postoperative adjuvant treatment. These factors can place a substantial economic and psychological burden on society and patients’ families ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Economic impact of metagenomic next-generation sequencing versus traditional bacterial culture for postoperative central nervous system infections using a decision analysis mode: study protocol for a randomized controlled trial

Tian,

Gao,

Wang

et al. 2023

mSystems

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Central nervous system infections (CNSIs) are common complications after neurosurgery with a poor prognosis. The traditional microbiological culture methodology has a low detection rate and time consuming. Metagenomic next-generation sequencing (mNGS) has demonstrated the advantages of being faster, more accurate, and more comprehensive in clinical microbiology. Previous studies had suggested that mNGS had a high sensitivity in the diagnosis of CNSIs. Whether the application of mNGS has health economic value in clinical applications remains to be studied. We designed a prospective, single-center, superiority randomized controlled trial to compare the cost-effectiveness of mNGS with traditional methods for diagnosing CNSIs using a decision tree model. A total of 204 patients will be enrolled and randomly assigned to either the mNGS group or the traditional method group. The two groups of patients entered different decision points according to different clinical manifestations and examination results. They will be then given treatment decisions by a panel of specialists at the corresponding decision point. The primary outcome is the incremental cost-effectiveness ratio, which is the increased cost for every 1% increase in recovery rate. The secondary outcomes are a comparison of time cost, detection cost, and costs associated with antibiotics treatment between the two groups. IMPORTANCE Diagnosing and treating postoperative central nervous system infections (PCNSIs) remains challenging due to the low detection rate and time-consuming nature of traditional methods for identifying microorganisms in cerebrospinal fluid. Metagenomic next-generation sequencing (mNGS) technology provides a rapid and comprehensive understanding of microbial composition in PCNSIs by swiftly sequencing and analyzing the microbial genome. The current study aimed to assess the economic impact of using mNGS versus traditional bacterial culture-directed PCNSIs diagnosis and therapy in post-neurosurgical patients from Beijing Tiantan Hospital. mNGS is a relatively expensive test item, and whether it has the corresponding health-economic significance in the clinical application of diagnosing intracranial infection has not been studied clearly. Therefore, the investigators hope to explore the clinical application value of mNGS detection in PCNSIs after neurosurgery.

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Estimating the excess bed days and economic burden of healthcare-associated infections in Singapore public acute-care hospitals

Cited by 7 publications

References 9 publications

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore

Estimating the economic cost of carbapenem resistant Enterobacterales healthcare associated infections in Singapore acute-care hospitals

Economic impact of metagenomic next-generation sequencing versus traditional bacterial culture for postoperative central nervous system infections using a decision analysis mode: study protocol for a randomized controlled trial

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