A PCR-based diagnostic testing strategy to identify carbapenemase-producing Enterobacteriaceae carriers upon admission to UK hospitals: early economic modelling to assess costs and consequences

Abstract

Background Carbapenemase-producing Enterobacteriaceae (CPE), bacteria which are resistant to the carbapenem class of antibiotics, present an urgent public health risk. The objective of this study was to assess the potential costs and consequences of implementing a testing strategy involving a polymerase chain reaction (PCR)-based diagnostic test for CPE amongst high risk patients upon admission to UK hospitals, to replace the current culture-based testing strategy. Methods A decision-analytic model was developed to estimate the expected medical care costs associated with a PCR testing strategy for CPE compared with the current culture testing strategy, and to consider the consequences, in terms of the diagnostic accuracy and associated cost implications, of each approach. The modelled population were patients admitted to hospital at high risk of colonisation with CPE, with model pathways for current practice based on those described in the Public Health England (PHE) toolkit for CPE testing. Costs were estimated from a UK National Health Service (NHS) perspective, with outcomes presented in terms of percentage of samples identified as true positive, false positive, true negative and false negative following each method of testing. Results Results indicated that the PCR testing strategy led to an estimated cost saving of £462 per patient for a 5-day hospital stay. For all sensitivity analyses conducted, PCR testing resulted in an expected cost saving. Potential cost savings approached £850 per patient for the sensitivity analysis assuming a 15-day hospital stay, indicating that PCR testing results in greater cost savings as length of stay increases. Fewer false positive, and more true negative, cases were identified with the PCR testing strategy in all analyses conducted. Conclusions This economic analysis gives an insight into the potential cost savings that could be made by the UK NHS through the introduction of a PCR-based diagnostic testing strategy to replace current recommended culture-based methods for the detection of CPE. Savings are due primarily to a faster time to result with PCR, meaning that CPE-free patients are not isolated unnecessarily. Therefore, a PCR-based diagnostic may aid appropriate use of isolation resource.

<p>Fecal Carriage and Epidemiology of Carbapenem-Resistant <em>Enterobacteriaceae</em> Among Hospitalized Patients in a University Hospital</p>

“…In this study, meropenem discs were used to screen rectal CRE. According to previous studies, meropenem discs screening method is a comparable method as that using entapenem discs or chromogenic medium for detecting rectal CRE 19,34,35…”

Cohorting for preventing the nosocomial spread of carbapenemase-producing Enterobacterales in non-epidemic settings: should it be mandatory?

“…Recent studies highlighted the use of polymerase chain reaction (PCR) versus culture-based methods. PCR can lead to cost saving and a better care of patients, especially by reducing the isolation duration [92,99,100].…”

Early-Stage Ovarian Malignancy Score versus Risk of Malignancy Indices: Accuracy and Clinical Utility for Preoperative Diagnosis of Women with Adnexal Masses

“…The NB of any risk model should be higher than the NB of the default strategies; otherwise, the model would be considered clinically harmful in its application. As the statistical significance and confidence intervals are not important in classical decision theory [ 31 ], we did not present the confidence intervals and p -values for the decision curve analysis.…”