Genomic Surveillance of Methicillin-resistant Staphylococcus aureus: A Mathematical Early Modeling Study of Cost-effectiveness

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.

Evolution of Outbreak-Causing Carbapenem-Resistant Klebsiella pneumoniae ST258 at a Tertiary Care Hospital over 8 Years

“…Tracking of multidrug-resistant and emergent hypervirulent bacterial lineages through WGS surveillance is critical to infection prevention. Early detection permits rapid implementation of interventions to prevent further transmission, which in turn reduces patient morbidity and mortality as well as health care costs (35, 41).…”

See and Sequence: Integrating Whole-Genome Sequencing Within the National Antimicrobial Resistance Surveillance Program in the Philippines

“…Control of healthcare-associated infections is crucial to containing the spread of antimicrobial resistance (29). The roadmap from sequence data to actionable data for infection control and prevention within a hospital has been mapped by multiple use cases (30,31) and supported by recent studies on implementation and cost-effectiveness in high-resource settings (32,33). This study makes a case for extending this roadmap to LMICs that have infection control capacity in place.…”

Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia

“…Their results were most sensitive to WGS cost and number of isolates sequenced each year. In the UK, Dymond et al 4 undertook an economic analysis that modelled MRSA genomic surveillance, compared with current practice, and found cost savings for genomic surveillance of ~£730 000 annually to the National Health Service. In Australia, our previous work on an ESBL E. coli outbreak in a single hospital also predicted significant cost savings and patient outcomes if WGS was implemented early as standard of care and avoided delays in response.…”

“…WGS can lead to reduced transmission and infection rates and lower overall costs. 4–6 These promising findings pave the way for a budget analysis to be performed to quantify the actual cost outlays required to adopt WGS on a population-wide scale.…”