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Cost-effectiveness analysis of universal screening for carbapenemase-producing Enterobacteriaceae in hospital inpatients

European Journal of Clinical Microbiology & Infectious Diseases volume 36, pages 1047–1055 (2017)Cite this article

Abstract

The purpose of this study was to assess the cost-effectiveness of screening all hospital inpatients for carbapenemase-producing Enterobacteriaceae (CPE) at the time of hospital admission, compared to not screening, from a US hospital perspective. We used a linked transmission/Markov model to compare outcomes for a typical hospitalized medical patient, from a community with a colonization prevalence of 0.05%. Outcomes were number of colonized patients, CPE-related clinical infections and deaths, expected quality-adjusted life years (QALYs), cost, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to assess the effect of parameter uncertainty, using a willingness-to-pay threshold of $100,000 per QALY gained. Screening prevented six CPE colonization cases per 1000 patients (1/1000 colonized with screening, 7/1000 without screening), over half of all symptomatic CPE infections (2/10,000 symptomatic with screening, 5/10,000 symptomatic without screening), and nearly half of all CPE-related deaths (8/100,000 deaths with screening, 15/100,000 deaths without screening). Screening accrued 0.0009 additional QALYs and cost an additional $24.68, compared to not screening, and was cost-effective (ICER $26,283 per QALY gained). Our results were sensitive to uncertainty in prevalence and the number of secondary colonizations per colonized patient. Screening was not cost-effective at a prevalence below 0.015% or if transmission to fewer than 0.9 new patients occurred for each colonized patient. At prevalence levels above 0.3%, screening was cost-saving compared to not screening. Screening inpatients for CPE carriage is likely cost-effective, and may be cost-saving, depending on the local prevalence of carriage.

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Acknowledgments

We thank David Naimark, MD MSc for the technical assistance with TreeAge during the model development.

Contributions

LL-S and TV are joint first authors, having contributed equally. Study concept and design: LL-S, TV, PK, H-HT, BS, AM. Analysis and interpretation of data: LL-S, TV. Drafting of the manuscript: LL-S, TV. Critical revision of the manuscript for important intellectual content: LL-S, TV, PK, H-HT, BS, AM. Statistical analysis: LL-S, TV.

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    Authors and Affiliations

    1. Department of Medicine, University of Toronto, Toronto, Canada

      L. Lapointe-Shaw

    2. Toronto General Hospital, 14 EN room 213, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada

      L. Lapointe-Shaw

    3. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

      T. Voruganti, P. Kohler & H.-H. Thein

    4. Public Health Ontario, Toronto, Canada

      B. Sander

    5. Sinai Health System, Toronto, Canada

      A. McGeer

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    1. L. Lapointe-Shaw
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    L. Lapointe-Shaw and T. Voruganti contributed equally to this work.

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    Lapointe-Shaw, L., Voruganti, T., Kohler, P. et al. Cost-effectiveness analysis of universal screening for carbapenemase-producing Enterobacteriaceae in hospital inpatients. Eur J Clin Microbiol Infect Dis 36, 1047–1055 (2017). https://doi.org/10.1007/s10096-016-2890-7

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    Keywords

    • Colistin
    • Screening Strategy
    • Tigecycline
    • Rectal Swab
    • Infection Control Practice