Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis

Stephen Mac; Tiffany Fitzpatrick; Jennie Johnstone; Beate Sander

doi:10.1186/s13756-019-0628-x

Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis

Antimicrob Resist Infect Control. 2019 Oct 29:8:168. doi: 10.1186/s13756-019-0628-x. eCollection 2019.

Authors

Stephen Mac^{1

2}, Tiffany Fitzpatrick³, Jennie Johnstone^{3

4

5}, Beate Sander^{1

2

5

6}

Affiliations

¹ 1Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada.
² 2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor, Room 247, Toronto, ON M5G 2C4 Canada.
³ 3Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON M5T 3M7 Canada.
⁴ 4Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, ON M5S 1A8 Canada.
⁵ 5Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON M5G 1V2 Canada.
⁶ 6ICES, G1 06, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada.

Abstract

Background: 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.

Methods: We 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.

Results: In 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.

Conclusion: VRE 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.

Keywords: Antimicrobial resistance; Cost-effectiveness analysis; Health economics; Hospital-acquired infection; Infection control; VRE; Vancomycin-resistant enterococci.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
Cross Infection / epidemiology*
Cross Infection / microbiology*
Cross Infection / transmission
Gram-Positive Bacterial Infections / epidemiology*
Gram-Positive Bacterial Infections / microbiology*
Gram-Positive Bacterial Infections / transmission
Health Care Costs
Humans
Ontario / epidemiology
Patients' Rooms*
Probability
Public Health Surveillance
Quality-Adjusted Life Years
Vancomycin-Resistant Enterococci / classification*
Vancomycin-Resistant Enterococci / isolation & purification*

Grants and funding

ISU-157466/CIHR/Canada