Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection

Abstract

IMPORTANCE Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. OBJECTIVE To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multiintervention bundles. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. INTERVENTIONS Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. MAIN OUTCOMES AND MEASURES Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). RESULTS In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers.

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force

“…Example of Item 12: Measurement of outcomes 101,102 "We conducted a cost-effectiveness analysis (CEA) alongside the cluster-randomized, controlled, multicenter, prospective DeTaMAKS-trial ..Further details on the recruitment strategy of DCCs and the eligibility criteria of DCCs and participants are described in detail elsewhere.The trial's registration number is ISRCTN16412551. The effect of MAKS on cognitive abilities was operationalized by the Mini Example of Item 13: Valuation of outcomes 116,117 "Under this approach, the health outcome in conventional costutility analyses, namely QALY, was monetised using individual WTP for an additional QALY gained.…”

Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

“… 4 , 6 , 8 , 9 , 40 , 42 In addition to reducing the burden of MDROs, costs are also an important consideration for intervention planning. Notably, the costs associated with MDRO infection 44 , 45 , 46 are often substantially higher than the costs of interventions (eg, CHG wipes are approximately $5.50-$7.50 per bath, 47 , 48 gloves and gowns are approximately $0.84 per use, 49 and educational and printing materials for an intervention campaign are approximately $4606 49 ). Furthermore, studies have reported that regional MDRO interventions (eg, registry, CHG bathing, and screening of interfacility transfers) are cost-saving.…”

Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

“…However, there might be a possible association between the number of interventions and the effectiveness of the programme-a simulation study found synergistic effects of combination interventions for MRSA control in nursing homes, assuming there were no resource constraints [85]. However, after taking cost into account, the more interventions simultaneously employed in the bundle did not correlate with a higher cost-effectiveness than an isolated daily cleaning intervention [86]. The challenge around resource constraints could explain why the number of components did not seem to affect the effectiveness of the programmes in our study.…”