Cost-effectiveness of carbapenem-resistant Enterobacteriaceae (CRE) surveillance in Maryland

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Lin, Gary ; Tseng, Katie K. ; Gatalo, Oliver ; Martinez, Diego A. ; Hinson, Jeremiah S. ; Milstone, Aaron M. ; Levin, Scott ; Klein, Eili
• Description:
  Objective:
  
  We analyzed the efficacy, cost, and cost-effectiveness of predictive decision-support systems based on surveillance interventions to reduce the spread of carbapenem-resistant Enterobacteriaceae (CRE).
  
  Design:
  
  We developed a computational model that included patient movement between acute-care hospitals (ACHs), long-term care facilities (LTCFs), and communities to simulate the transmission and epidemiology of CRE. A comparative cost-effectiveness analysis was conducted on several surveillance strategies to detect asymptomatic CRE colonization, which included screening in ICUs at select or all hospitals, a statewide registry, or a combination of hospital screening and a statewide registry.
  
  Setting:
  
  We investigated 51 ACHs, 222 LTCFs, and skilled nursing facilities, and 464 ZIP codes in the state of Maryland.
  
  Patients or participants:
  
  The model was informed using 2013–2016 patient-mix data from the Maryland Health Services Cost Review Commission. This model included all patients that were admitted to an ACH.
  
  Results:
  
  On average, the implementation of a statewide CRE registry reduced annual CRE infections by 6.3% (18.8 cases). Policies of screening in select or all ICUs without a statewide registry had no significant impact on the incidence of CRE infections. Predictive algorithms, which identified any high-risk patient, reduced colonization incidence by an average of 1.2% (3.7 cases) without a registry and 7.0% (20.9 cases) with a registry. Implementation of the registry was estimated to save $572,000 statewide in averted infections per year.
  
  Conclusions:
  
  Although hospital-level surveillance provided minimal reductions in CRE infections, regional coordination with a statewide registry of CRE patients reduced infections and was cost-effective.
  
  
• Subjects:
  Anti-Bacterial Agents Carbapenem-Resistant Enterobacteriaceae Cost-Benefit Analysis Cross Infection Enterobacteriaceae Infections Humans Maryland
• Source:
  Infect Control Hosp Epidemiol. :1-9
• Pubmed ID:
  34674791
• Pubmed Central ID:
  PMC9023597
• Document Type:
  Journal Article
• Funding:
  U01 CK000536/CK/NCEZID CDC HHSUnited States/ ; U01 CK000589/CK/NCEZID CDC HHSUnited States/
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:9e10a992888848265881a8f534c77852a1d34349b969ab45fe9d4b59df7f762efe8f8d78e594411219742f092b5ca35416a898fd769aaa7491edb9fafc95fce6
• Download URL:
  https://stacks.cdc.gov/view/cdc/116647/cdc_116647_DS1.pdf
• File Type:
  [PDF - 1000.14 KB ]