VRE screening in a low incidence population: An analysis of cost effectiveness

Abstract

Vancomycin resistant enterococci (VRE) colonisation is common in Australian hospitals. This study aimed to review the cost effectiveness of the VRE screening protocol at a regional tertiary hospital. Data from one year of VRE screening was analysed. Of the 4498 tests performed, inter-hospital transfer (IHT; n=1542) was the most common indication. IHT and initial screen on admission to ICU were associated with a low probability of isolating VRE compared to the referent indication (previous VRE). The odds ratio (OR) for isolating VRE following IHT from a tertiary hospital was 2.23 (n=11/442; 95% CI 0.9–5.8) compared to an IHT from a hospital within the health district (n=12/1063). The adjusted OR, when accounting for time spent at the referral hospital (≤ or >48 hours), was 1.2 (95% CI 0.5–2.9). However, the crude and adjusted odds ratio for patient admissions >48 hours at any IHT hospital [7.0 (95% CI 2.8–19.5) and 6.6 (95% CI 2.6–19.2), respectively] suggest that ceasing VRE screening of patients transferred after spending less than 48 hours at a referring facility would have the least impact on program efficacy. Accounting for a cost of $19.85 per swab, this would have a projected cost saving of $21,041 per year.