The cost bloodstream infections caused by antimicrobial susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals

Stewardson, AJ; Graves, Nicholas; Allignol, Arthur; Harbarth, Stéphan Juergen

doi:10.1186/2047-2994-4-s1-o55

Cited by 33 publications

(56 citation statements)

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“…To this end, the choice of a composite endpoint is twofold: First, expected excess lengthof-stay not distinguishing between discharge alive and death is the common quantity of interest in cost-benefit analyses. Second, the vast majority of patients is typically discharged alive from the ICU in studies on hospital-acquired infection even though mortality in our study (in the data example below: approximately 25%) is higher as, for example, in the study of Stewardson et al (2016).…”

Section: The Three-state Illness-death Model Without Recoverymentioning

confidence: 64%

“…However, future research has to focus on the stabilization of extreme pseudovalues by, for instance, transformations (cf. Stewardson et al, 2016, for an example), suitable link functions, or the exclusion of extreme cases. This may improve model fitting.…”

Section: Discussionmentioning

confidence: 99%

“…The timescale of interest is days since first ventilation until end-of-ICU-stay, which combines ICU death and discharge alive (whatever occurs first). In order to limit the influence of outliers, ICU admissions are administratively rightcensored at day 45 (following the approach in Stewardson et al, 2016). The margin corresponds to the 95% quantile of the LoS distribution before censoring (median LoS: 10 days, interquartile range [5,18], see also Supporting Figure S2).…”

Section: Data Examplementioning

confidence: 99%

“…This concept of expected excess LoS has been successfully applied in numerous studies (cf. De Angelis et al, 2011;de Kraker et al, 2011;Macedo-Vinas et al, 2013;Stewardson et al, 2016;Van Kleef et al, 2014;Wolkewitz, von Cube, & Schumacher, 2017, for recent examples).…”

mentioning

confidence: 99%

“…These pseudovalues are further incorporated into a generalized linear model as dependent variable. Stewardson et al (2016) applied this technique to model the impact of baseline confounding on the expected excess LoS associated with nosocomial infection, but properties have not been investigated. A methodological work based on the more general illness-death model with recovery combining the concept of pseudovalues with landmarking has recently been published by Grand and Putter (2016); however, they have considered the expected LoS in a given state of a multistate model, but not the expected excess LoS (here: in ICU) as the main quantity of interest.…”

mentioning

confidence: 99%

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Estimation of adjusted expected excess length‐of‐stay associated with ventilation‐acquired pneumonia in intensive care: A multistate approach accounting for time‐dependent mechanical ventilation

Bluhmki¹,

Allignol

Ruckly

et al. 2018

Biometrical J

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The expected excess length-of-stay is an established concept to assess the health and economic impact of nosocomial, that is, hospital-acquired infections such as ventilation-acquired pneumonia in intensive care. Estimation must account for the timing of infection as in a multistate perspective, because common retrospective comparisons yield inflated estimates due to time-dependent bias. Since occurrence of ventilation-acquired pneumonia is closely linked to ventilation status, we suggest a multistate model incorporating time-dependent mechanical ventilation as additional states. The appeal is that the expected excess length-of-stay decomposes into extra days spent under ventilation and not under ventilation. This is not only highly relevant from a patient's perspective regarding quality of life, but also from an economic point of view, because ventilation is a major cost driver. The challenge is that estimation involves complex functionals of the matrix of transition probabilities, which in turn are based on the transition hazards. To address heterogeneity between patients, which is a common phenomenon in observational hospital epidemiology, we apply pseudovalue regression to adjust the ventilation-specific quantities for baseline confounding. The performance of our proposal is assessed by simulation and the methods are illustrated on data provided by 12 French intensive care units. Preliminary results indicate that the expected excess length-of-stay associated with ventilation-acquired pneumonia is mainly triggered by extra days spent under mechanical ventilation, and that the excess is most pronounced for intensive care patients with fewer comorbidities at baseline. We also find that such a decomposition is challenging for early times. Example code is provided.

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Section: The Three-state Illness-death Model Without Recoverymentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Data Examplementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Estimation of adjusted expected excess length‐of‐stay associated with ventilation‐acquired pneumonia in intensive care: A multistate approach accounting for time‐dependent mechanical ventilation

Bluhmki¹,

Allignol

Ruckly

et al. 2018

Biometrical J

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Is antimicrobial stewardship cost-effective? A narrative review of the evidence

Naylor

Zhu

Hulscher³

et al. 2017

Clinical Microbiology and Infection

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AIMS: This narrative review aimed to collate recent evidence on the cost-effectiveness and cost-benefit of antimicrobial stewardship (AMS) programmes, to address the question 'is AMS cost-effective?', while providing resources and guidance for future research in this area. SOURCES: PubMed was searched for studies assessing the cost-effectiveness, cost-utility or cost-benefit of AMS interventions in humans, published from January 2000 to March 2017, with no setting inclusion/exclusion criteria specified. Reference lists of retrieved reviews were searched for additional articles. CONTENT: Recent evidence on the cost-effectiveness and cost-benefit of AMS is described, studies suggest persuasive and structural AMS interventions may provide health economic benefits to the hospital setting. However, overall, cost-effectiveness evidence for AMS is severely limited, especially for the community setting. Recommendations for future research in this area are therefore provided, including discussion of appropriate health economic methodological choice. IMPLICATIONS: Health systems have a finite and decreasing resource, decision makers currently do not have necessary evidence to assess whether AMS programmes provide sufficient benefits. Although the evidence-base of the cost-effectiveness of AMS is increasing, it remains inadequate for investment decision-making. Robust health economics research needs to be completed to enhance the generalizability and usability of cost-effectiveness results

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Surgical site infection with extended-spectrum β-lactamase-producing Enterobacteriaceae after cardiac surgery: incidence and risk factors

Jolivet

Lescure

Armand-Lefèvre

et al. 2018

Clinical Microbiology and Infection

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The cost bloodstream infections caused by antimicrobial susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals

Cited by 33 publications

References 0 publications

Estimation of adjusted expected excess length‐of‐stay associated with ventilation‐acquired pneumonia in intensive care: A multistate approach accounting for time‐dependent mechanical ventilation

Estimation of adjusted expected excess length‐of‐stay associated with ventilation‐acquired pneumonia in intensive care: A multistate approach accounting for time‐dependent mechanical ventilation

Is antimicrobial stewardship cost-effective? A narrative review of the evidence

Surgical site infection with extended-spectrum β-lactamase-producing Enterobacteriaceae after cardiac surgery: incidence and risk factors

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