An Economic Evaluation Estimating the Clinical and Economic Burden of Increased Vancomycin-Resistant Enterococcus faecium Infection Incidence in Japan

Abstract

Introduction While incidence rates of vancomycin-resistant Enterococcus faecium have remained comparatively low in Japan, there have been increasing reports of more vancomycin-resistant Enterococcus (VRE) outbreaks, requiring costly measures to contain. Increased incidence of VRE in Japan may lead to more frequent and harder to contain outbreaks with current control measures, causing a significant burden to the healthcare system in Japan. This study aimed to demonstrate the clinical and economic burden of vancomycin-resistant E. faecium infections to the Japanese healthcare system and the impact of increasing rates of vancomycin resistance. Methods A de novo deterministic analytic model was developed to assess the health economic outcomes of treating hospital-acquired VRE infections; patients are treated according to a two-line treatment strategy, dependent on their resistance status. The model considers hospitalisation costs and the additional cost of infection control. Scenarios investigated the current burden of VRE infections and the additional burden of increased incidence of VRE. Outcomes were assessed over a 1-year and 10-year time horizon from a healthcare payer’s perspective in a Japanese setting. Quality-adjusted life years (QALYs) were valued with a willingness-to-pay threshold of ¥5,000,000 ($38,023), and costs and benefits were discounted at a rate of 2%. Results Current VRE incidence levels in enterococcal infections in Japan equates to ¥130,209,933,636 ($996,204,669) in associated costs and a loss of 185,361 life years (LYs) and 165,934 QALYs over 10 years. A three-fold increase (1.83%) is associated with an additional ¥4,745,059,504 ($36,084,651) in total costs on top of the current cost burden as well as an additional loss of 683 LYs over a lifetime, corresponding to 616 QALYs lost. Conclusion Despite low incidence rates, VRE infections already represent a substantial economic burden to the Japanese healthcare system. The substantial increase in costs associated with a higher incidence of VRE infections could result in a significant economic challenge for Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00826-w.

Epidemiology of vancomycin-resistant enterococci in the United Arab Emirates: a retrospective analysis of 12 years of national AMR surveillance data

“…There is conflicting data on the role of vancomycin-resistant enterococci (VRE) in severe infections concerning their contribution to increased mortality ( 34 – 37 ). However, there are potentially more tenacious and/or pathogenic VRE clones which remain for extended periods in specific hospitals and as a consequence, are involved in nosocomial outbreaks ( 38 – 42 ) combined with a high economic burden ( 43 – 45 ).…”

Genomic analysis of inter-hospital transmission of vancomycin-resistant Enterococcus faecium sequence type 80 isolated during an outbreak in Hiroshima, Japan

“…Most enterococci isolated in clinical settings are Enterococcus faecium and Enterococcus faecalis , with E. faecium tending to be more multidrug-resistant than E. faecalis . To treat the infections, ampicillin is the first-choice antibiotic if E. faecium is susceptible ( 1 ). However, vancomycin, an active glycopeptide antibiotic against Gram-positive bacteria, becomes essential as most E. faecium bacteria in Japan are ampicillin-resistant ( 1 – 6 ).…”

“…To treat the infections, ampicillin is the first-choice antibiotic if E. faecium is susceptible ( 1 ). However, vancomycin, an active glycopeptide antibiotic against Gram-positive bacteria, becomes essential as most E. faecium bacteria in Japan are ampicillin-resistant ( 1 – 6 ). Outbreaks of nosocomial infections caused by vancomycin-resistant enterococci (VRE) have recently increased in Europe and Australia, as E. faecium belongs to clonal complex 17 (CC17) ( 7 – 11 ).…”