No abstract

Background Genomic surveillance of methicillin-resistant Staphylococcus aureus (MRSA) identifies unsuspected transmission events and outbreaks. Used proactively, this could direct early and highly targeted infection control interventions to prevent ongoing spread. Here, we evaluated the cost-effectiveness of this intervention in a model that compared whole-genome sequencing plus current practice versus current practice alone. Methods A UK cost-effectiveness study was conducted using an early model built from the perspective of the National Health Service and personal social services. The effectiveness of sequencing was based on the relative reduction in total MRSA acquisitions in a cohort of hospitalized patients in the year following their index admissions. A sensitivity analysis was used to illustrate and assess the level of confidence associated with the conclusions of our economic evaluation. Results A cohort of 65 000 patients were run through the model. Assuming that sequencing would result in a 90% reduction in MRSA acquisition, 290 new MRSA cases were avoided. This gave an absolute reduction of 28.8% and avoidance of 2 MRSA-related deaths. Base case results indicated that the use of routine, proactive MRSA sequencing would be associated with estimated cost savings of over £728 290 per annual hospitalized cohort. The impact in total quality-adjusted life years (QALYs) was relatively modest, with sequencing leading to an additional 14.28 QALYs gained. Results were most sensitive to changes in the probability of a MRSA-negative patient acquiring MRSA during their hospital admission. Conclusions We showed that proactive genomic surveillance of MRSA is likely to be cost-effective. Further evaluation is required in the context of a prospective study.

The lake sediment phosphorus (P) record at Hatch Mere (Cheshire, UK) is investigated to assess the role of human activity in modifying Holocene landscape P export dynamics, and to develop an approach to incorporating this effect into a pre-existing long-term, large-scale landscape model of natural P export. Analysis of the lake sediment record shows that the catchment P yield is low and constant prior to ca. 6000 BP, but then increases up to the present day. This increase occurs in steps that coincide with the Neolithic, Bronze Age and Medieval periods, and the first half of the 20th century, consistent with an anthropogenic cause. Such an interpretation is supported by close correlation of the P export flux with the estimated regional population density. We demonstrate that the effect of human activity on landscape P dynamics can be incorporated into the existing P export model by scaling the soil secondary P leakage rate coefficient to population density. The findings of this study suggest that lake sediment P accumulation rate data may provide a novel method for estimating prehistoric local population density. Additionally, we show that the pre-Neolithic landscape P export was low, and we reject the widely held view that Hatch Mere is naturally eutrophic.

Background: Stroke is a significant burden in Saudi Arabia and the Saudi Ministry of Health's stroke committee has identified an urgent need to improve care.Aim: The purpose of this study was to undertake a health-economic analysis to quantify the impact of developing stroke care in the country.Methods: An economic model was developed to assess the costs and clinical outcomes associated with an ischemic stroke care development program compared with current stroke care. Based on Saudi epidemiological data, cohorts of ischemic stroke patients enter the model each year for the first 10 years based on increasing incidence. Four treatment options were modeled including reperfusion and non-reperfusion treatments. The development scenario estimates the impact of gradually increasing uptake of more effective treatments over 10 years. Changes in the stroke care organization are considered along with resources required to increase capacity, allowing more patients to be admitted to stroke hospitals and access effective treatments.Results: The stroke care development program is associated with an increase in functionally independent patients and a decrease in disabling strokes compared with current stroke care. Additionally, the development program is associated with estimated cost savings of $602 million over 15 years ($255 million direct costs, $348 million indirect costs). Conclusions:The model predicts that the stroke care development program is associated with improved patient outcomes and lower overall costs compared with the current stroke care program.