Abstract
BackgroundVancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective.MethodsWe developed a microsimulation model using local data and VRE literature, to simulate a 20-bed general medicine ward at a tertiary-care hospital with up to 1000 admissions, approximating 1 year. Primary outcomes were accrued over the patient’s lifetime, discounted at 1.5%, and included expected health outcomes (VRE colonisations, VRE infections, VRE-related bacteremia, and deaths subsequent to VRE infection), quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess parameter uncertainty.ResultsIn our base-case analysis, VRE screening and isolation prevented six healthcare-associated VRE colonisations per 1000 admissions (6/1000), 0.6/1000 VRE-related infections, 0.2/1000 VRE-related bacteremia, and 0.1/1000 deaths subsequent to VRE infection. VRE screening and isolation accrued 0.0142 incremental QALYs at an incremental cost of $112, affording an ICER of $7850 per QALY. VRE screening and isolation practice was more likely to be cost-effective (> 50%) at a cost-effectiveness threshold of $50,000/QALY. Stochasticity (randomness) had a significant impact on the cost-effectiveness.ConclusionVRE screening and isolation can be cost-effective in majority of model simulations at commonly used cost-effectiveness thresholds, and is likely economically attractive in general medicine settings. Our findings strengthen the understanding of VRE prevention strategies and are of importance to hospital program planners and infection prevention and control.
Highlights
Vancomycin-resistant enterococci (VRE) are a class of antimicrobial resistant (AMR) bacteria most commonly transmitted within healthcare settings [1]
Base-case analysis In Table 2, we summarized the estimated health outcomes, costs and incremental cost-effectiveness ratio (ICER) for the VRE screening and isolation strategy compared to no VRE screening and isolation over 1000 admissions for our base-case analysis
Uncertainty: probabilistic sensitivity analysis Figure 4 illustrates a costeffectiveness acceptability curve (CEAC) where at low cost-effectiveness threshold (CET) below $7500/quality-adjusted life years (QALY), it was unlikely that VRE screening and isolation was a cost-effective strategy
Summary
Vancomycin-resistant enterococci (VRE) are a class of antimicrobial resistant (AMR) bacteria most commonly transmitted within healthcare settings [1]. Patients who develop VRE-related infections require longer hospital stays, have a higher risk of mortality, and substantially higher medical costs. A study from Canada estimated the mean attributable cost and length of stay for patients with VRE colonisation/infection to be $17,949 and 13.8 days, respectively, when compared to patients without VRE [3]. Mac et al Antimicrobial Resistance and Infection Control (2019) 8:168 control of VRE spread through vancomycin usage, screening and isolation of patients with VRE in hospital settings, education, cleaning and contact precautions (e.g. gloves) [4, 5]. Vancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective
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