Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis

Abstract

BackgroundVancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective.MethodsWe developed a microsimulation model using local data and VRE literature, to simulate a 20-bed general medicine ward at a tertiary-care hospital with up to 1000 admissions, approximating 1 year. Primary outcomes were accrued over the patient’s lifetime, discounted at 1.5%, and included expected health outcomes (VRE colonisations, VRE infections, VRE-related bacteremia, and deaths subsequent to VRE infection), quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess parameter uncertainty.ResultsIn our base-case analysis, VRE screening and isolation prevented six healthcare-associated VRE colonisations per 1000 admissions (6/1000), 0.6/1000 VRE-related infections, 0.2/1000 VRE-related bacteremia, and 0.1/1000 deaths subsequent to VRE infection. VRE screening and isolation accrued 0.0142 incremental QALYs at an incremental cost of $112, affording an ICER of $7850 per QALY. VRE screening and isolation practice was more likely to be cost-effective (> 50%) at a cost-effectiveness threshold of $50,000/QALY. Stochasticity (randomness) had a significant impact on the cost-effectiveness.ConclusionVRE screening and isolation can be cost-effective in majority of model simulations at commonly used cost-effectiveness thresholds, and is likely economically attractive in general medicine settings. Our findings strengthen the understanding of VRE prevention strategies and are of importance to hospital program planners and infection prevention and control.

Clonal distribution of vancomycin‐resistant Enterococcus faecium in Turkey and the new singleton ST733

“…The distribution of a total of 71 nonduplicate VREfm received from inpatients treated at university or training hospitals in seven various hospitals of Turkey were as follows: Istanbul Faculty of Medicine (n = 11), Istanbul University‐Cerrahpaşa, Cerrahpasa Faculty of Medicine (n=6), 6 Haydarpasa GATA (n=14), 14 Ankara GATA (n=1), 1 Ege University (n=17), 17 Akdeniz University, 11 and Van Yüzüncü Yıl University 9 . All the 71 VREfm isolates were noted to have been recovered from hospitalized patients and thus represented healthcare‐associated isolates and infections.…”

“…The source of these isolates was as follows: majority of isolates obtained from blood 84.5% (n = 39), urine (n = 21), 15.5% from surgical wound specimens (n=3), 3 cerebrospinal fluid (n=2), abscess (n=2), 2 bronchoalveolar lavage (n=1), 1 catheter tube (n=2), 2 and transtracheal fluid samples (n=1), respectively.…”

“…The most common infections associated with VRE are bacteremia, endocarditis, and urinary system infections. 1,2 Various risk factors which significantly contributed to the invasive VRE infections and caused mortality were described before. Long period of hospitalization in the intensive care, transplant, hematology, or oncology units, receiving hemodialysis, contact with patients diagnosed with VRE, enteral feeding, corticosteroid use, administration of antineoplastic treatment, sucralfate use, and the history of the use of antibiotic (vancomycin, second-or third-generation cephalosporins, metronidazole, clindamycin, imipenem, ticarcillin-clavulanic acid) were reported as the risk factors.…”

“…The most common infections associated with VRE are bacteremia, endocarditis, and urinary system infections 1,2 . Various risk factors which significantly contributed to the invasive VRE infections and caused mortality were described before.…”

“…Various risk factors which significantly contributed to the invasive VRE infections and caused mortality were described before. Long period of hospitalization in the intensive care, transplant, hematology, or oncology units, receiving hemodialysis, contact with patients diagnosed with VRE, enteral feeding, corticosteroid use, administration of antineoplastic treatment, sucralfate use, and the history of the use of antibiotic (vancomycin, second‐ or third‐generation cephalosporins, metronidazole, clindamycin, imipenem, ticarcillin‐clavulanic acid) were reported as the risk factors 1‐5 . Allogenic bone marrow transplant, neutropenia, use of central venous line, and hypoalbuminemia were described as the independent risk factors in the development of the VRE bacteremia in the multi‐variant analyses 6‐9 …”