Abstract
Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multi-intervention bundles. This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers. Screening at admission cost $1283/QALY, while health care worker contact precautions and visitor hand hygiene interventions cost $123 264/QALY and $5 730 987/QALY, respectively. Visitor contact precautions was dominated, with increased cost and decreased QALYs. Adding screening, health care worker hand hygiene, and patient hand hygiene sequentially to the daily cleaning intervention formed 2-pronged, 3-pronged, and 4-pronged multi-intervention bundles that cost an additional $29 616/QALY, $50 196/QALY, and $146 792/QALY, respectively. The findings of this study suggest that institutions should seek to streamline their infection control initiatives and prioritize a smaller number of highly cost-effective interventions. Daily sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions.
Highlights
Clostridioides difficile is the most common hospital-acquired infection in the United States, responsible for more than 15 000 deaths and $5 billion in direct health care costs annually.[1]
MAIN OUTCOMES AND MEASURES Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices
Sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions
Summary
Clostridioides difficile is the most common hospital-acquired infection in the United States, responsible for more than 15 000 deaths and $5 billion in direct health care costs annually.[1]. Efforts to control C difficile infection (CDI) have intensified in recent years, with the addition of CDI to Medicare’s Hospital-Acquired Condition Reduction Program.[2] the results of targeted infection control initiatives have been variable, and CDI incidence continues to rise.[1,3,4]. Nationwide, interventions are typically implemented simultaneously in multi-intervention bundles.[3] This strategy makes it impossible to identify the isolated effects of single interventions using traditional epidemiologic methods.[5] by developing an agent-based simulation model of C difficile transmission, our group was previously able to evaluate the clinical effectiveness of 9 interventions and 8 multi-intervention bundles in a simulated general, 200-bed, adult hospital.[6] All hospitals operate in a setting of constrained resources. Evaluating the cost-effectiveness of common infection control interventions is essential to providing evidence-based recommendations regarding which strategies to prioritize and implement
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