title: Cost-Effectiveness of a Model Infection Control Program for Preventing Multi-Drug-Resistant Organism Infections in Critically Ill Surgical Patients.
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.
authors.affiliation: 1 Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University , Richmond, Virginia.|2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts.
authors.forename: Sudha P
authors.initials: SP
authors.lastname: Jayaraman
authors.affiliation: 3 Department of Health Policy and Management and Center for Health Decision Science , Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Yushan
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: 3 Department of Health Policy and Management and Center for Health Decision Science , Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Stephen
authors.initials: S
authors.lastname: Resch
authors.affiliation: 2 Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School , Boston, Massachusetts.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: 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.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D001424:Bacterial Infections / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000191:economics*; D003428:Cross Infection / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative