Sudha P Jayaraman1,2, Yushan Jiang3, Stephen Resch3, Reza Askari2, Michael Klompas4. 1. 1 Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University , Richmond, Virginia. 2. 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts. 3. 3 Department of Health Policy and Management and Center for Health Decision Science , Harvard School of Public Health, Boston, Massachusetts. 4. 4 Division of Infectious Disease, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, and Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston, Massachusetts.
Abstract
BACKGROUND: Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. METHODS: We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. RESULTS: The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. CONCLUSIONS: This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.
BACKGROUND: Interventions to contain two multi-drug-resistant Acinetobacter (MDRA) outbreaks reduced the incidence of multi-drug-resistant (MDR) organisms, specifically methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile in the general surgery intensive care unit (ICU) of our hospital. We therefore conducted a cost-effective analysis of a proactive model infection-control program to reduce transmission of MDR organisms based on the practices used to control the MDRA outbreak. METHODS: We created a model of a proactive infection control program based on the 2011 MDRA outbreak response. We built a decision analysis model and performed univariable and probabilistic sensitivity analyses to evaluate the cost-effectiveness of the proposed program compared with standard infection control practices to reduce transmission of these MDR organisms. RESULTS: The cost of a proactive infection control program would be $68,509 per year. The incremental cost-effectiveness ratio (ICER) was calculated to be $3,804 per aversion of transmission of MDR organisms in a one-year period compared with standard infection control. On the basis of probabilistic sensitivity analysis, a willingness-to-pay (WTP) threshold of $14,000 per transmission averted would have a 42% probability of being cost-effective, rising to 100% at $22,000 per transmission averted. CONCLUSIONS: This analysis gives an estimated ICER for implementing a proactive program to prevent transmission of MDR organisms in the general surgery ICU. To better understand the causal relations between the critical steps in the program and the rate reductions, a randomized study of a package of interventions to prevent healthcare-associated infections should be considered.
Authors: Praveen Kumar; Alexander J Sundermann; Elise M Martin; Graham M Snyder; Jane W Marsh; Lee H Harrison; Mark S Roberts Journal: Clin Infect Dis Date: 2021-07-01 Impact factor: 9.079
Authors: Vincent I Lau; Bram Rochwerg; Feng Xie; Jennie Johnstone; John Basmaji; Jana Balakumaran; Alla Iansavichene; Deborah J Cook Journal: Can J Anaesth Date: 2019-11-12 Impact factor: 5.063