The Economic Value of the Centers for Disease Control and Prevention Carbapenem-Resistant Enterobacteriaceae Toolkit

Abstract

OBJECTIVE While previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur. DESIGN Economic analysis SETTING Orange County, California METHODS Using our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances. RESULTS Compared to routine control measures, screening generated cost savings by year 1 when hospitals implemented screening after identifying ≤20 CRE cases (saving $2,000–$9,000) and by year 7 if all hospitals implemented in a regional coordinated manner after 1 hospital identified a CRE case (hospital perspective). Cost savings was achieved only if hospitals independently screened after identifying 10 cases (year 1, third-party payer perspective). Cost savings was achieved by year 1 if hospitals independently screened after identifying 1 CRE case and by year 3 if all hospitals coordinated and screened after 1 hospital identified 1 case (societal perspective). After a few years, all strategies cost less and have positive health effects compared to routine control measures; most strategies generate a positive cost-benefit each year. CONCLUSIONS Active screening of interfacility transfers garnered cost savings in year 1 of implementation when hospitals acted independently and by year 3 if all hospitals collectively implemented the toolkit in a coordinated manner. Despite taking longer to manifest, coordinated regional control resulted in greater savings over time.

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

“…[22] In fact, colonization with CRE was more commonly known to the facility, which likely reflected an ongoing effort by LTACs to conduct screening for CRE on admission and communication CRE status on transfer to other healthcare facilities. [27,36] Our data represent the largest MDRO point prevalence study published to date in NH and LTAC settings. Our study is limited in that we conducted surveillance only within a subset of more highly connected facilities southern California.…”

“…[26] Investment of resources in regional infection prevention programs that focus on NHs and LTACs has potential to attenuate the spread of MDROs and prevent morbidity and mortality across the U.S. healthcare system. [15,27] The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County (SHIELD OC) is a large Southern California regional public health collaborative funded and supported by CDC and endorsed by the Orange County Health Care Agency and the California Department of Public Health. SHIELD OC involves 38 out of 104 healthcare facilities in Orange County, California.…”

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

“…Screening and surveillance of patients seems to be the most adopted measure [37]. Moreover, active screening could allow cost savings after one to three years of implementation [92].…”

“…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].…”

Implementing a toolkit for the prevention, management and control of carbapenemase-producing Enterobacteriaceae in English acute hospitals trusts: a qualitative evaluation

“…A task force or implementation team consisting of different target group representatives and tools for conducting stakeholder analyses or leadership support assessments are promising options [63, 64]. Leadership support could further be encouraged, if necessary, by providing information on cost savings due to outbreak prevention measures [65, 66]. Overall, acute trust representatives should be involved in the revision of the guidelines and multidisciplinary collaborations at trust level should be encouraged to revise local policies.…”