Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States

Abstract

Objectives The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat; however, its economic burden is unknown. Methods We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third-party payer, and societal, perspectives and to evaluate the health and economic burden of CRE to the USA. Results Depending on the infection type, the median cost of a single CRE infection can range from $22 484 to $66 031 for hospitals, $10 440 to $31 621 for third-party payers, and $37 778 to $83 512 for society. An infection incidence of 2.93 per 100 000 population in the USA (9418 infections) would cost hospitals $275 million (95% CR $217–334 million), third-party payers $147 million (95% CR $129–172 million), and society $553 million (95% CR $303–1593 million) with a 25% attributable mortality, and would result in the loss of 8841 (95% CR 5805–12 420) quality-adjusted life years. An incidence of 15 per 100 000 (48 213 infections) would cost hospitals $1.4 billion (95% CR $1.1–1.7 billion), third-party payers $0.8 billion (95% CR $0.6–0.8 billion), and society $2.8 billion (95% CR $1.6–8.2 billion), and result in the loss of 45 261 quality-adjusted life years. Conclusions The cost of CRE is higher than the annual cost of many chronic diseases and of many acute diseases. Costs rise proportionally with the incidence of CRE, increasing by 2.0 times, 3.4 times, and 5.1 times for incidence rates of 6, 10, and 15 per 100 000 persons.

Carbapenem-Nonsusceptible Gram-Negative Pathogens in ICU and Non-ICU Settings in US Hospitals in 2017: A Multicenter Study

“…The problem of carbapenem resistance in this pathogen is magnified by the paucity of options for the treatment of CRE [11], which may lead to inappropriate initial therapy [14]. At current rates, CRE infections are estimated to result in a 26% mortality rate and cost hospitals $275 million annually [2]. …”

“…Increasing resistance to carbapanems thus jeopardizes patient outcomes and results in a significant economic burden [2, 3]. The increased morbidity and mortality associated with antibiotic resistance is of particular concern in vulnerable populations such as patients in intensive care units (ICUs) [4].…”

Multidrug‐resistant Klebsiella pneumoniae in hospital‐acquired infections: Concomitant analysis of antimicrobial resistant strains

“…Those are the ambler molecular class A (KPC), class B (VIM, IMP and NDM) and class D (OXA‐48) types . The genes of these enzymes are located on plasmids and can be freely transferred between bacteria . Plasmids can carry also several resistance determinants, such as plasmid‐mediated quinolone resistance (PMQR) genes, that has been reported in gram negative bacilli including K pneumoniae in the past few decades all over the world.…”

“…9 Horizontal transfer of plasmids has been identified as an important mechanism spread of multidrug resistance spread all over the world. 8 Early detection of multidrug resistance by rapid diagnostic techniques may limit their spread, particularly in hospitals. 10 Whilst many researchers have studied plasmids which carry qnr genes along with β-lactamase genes, 11,12 relatively, little is reported about the association between qnr genes and carbapenemase genes in resistant K pneumoniae strains.…”

The Economic Value of the Centers for Disease Control and Prevention Carbapenem-Resistant Enterobacteriaceae Toolkit

“…Moreover, CRE are considered an urgent public health threat, 3 and a single CRE infection in the United States can cost society up to $83,512. 4 Our previous work demonstrated that 1 part of the CDC CRE toolkit (ie, active screening of interfacility transfers with subsequent contact precautions) was better than measures currently used in most healthcare facilities (eg, contact precautions only for known carriers) in a region where CRE is newly emerging. 1 The CDC CRE toolkit can be implemented in 2 ways: in individual facilities or in a coordinated regional fashion.…”