title: Potential economic burden of carbapenem-resistant Enterobacteriaceae (CRE) in the United States.
abstract: OBJECTIVE
  The Centers for Disease Control and Prevention considers carbapenem-resistant Enterobacteriaceae (CRE) an urgent public health threat; however, its economic burden is unknown.
  
  
  METHODS
  We developed a CRE clinical and economics outcomes model to determine the cost of CRE infection from the hospital, third-party payer, and societal, perspectives and to evaluate the health and economic burden of CRE to the USA.
  
  
  RESULTS
  Depending on the infection type, the median cost of a single CRE infection can range from $22 484 to $66 031 for hospitals, $10 440 to $31 621 for third-party payers, and $37 778 to $83 512 for society. An infection incidence of 2.93 per 100 000 population in the USA (9418 infections) would cost hospitals $275 million (95% CR $217-334 million), third-party payers $147 million (95% CR $129-172 million), and society $553 million (95% CR $303-1593 million) with a 25% attributable mortality, and would result in the loss of 8841 (95% CR 5805-12 420) quality-adjusted life years. An incidence of 15 per 100 000 (48 213 infections) would cost hospitals $1.4 billion (95% CR $1.1-1.7 billion), third-party payers $0.8 billion (95% CR $0.6-0.8 billion), and society $2.8 billion (95% CR $1.6-8.2 billion), and result in the loss of 45 261 quality-adjusted life years.
  
  
  CONCLUSIONS
  The cost of CRE is higher than the annual cost of many chronic diseases and of many acute diseases. Costs rise proportionally with the incidence of CRE, increasing by 2.0 times, 3.4 times, and 5.1 times for incidence rates of 6, 10, and 15 per 100 000 persons.
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Bartsch
authors.affiliation: Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA; Torrance Memorial Medical Center, Torrance, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: McKinnell
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: L E
authors.initials: LE
authors.lastname: Mueller
authors.affiliation: Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Miller
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, CA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Gohil
authors.affiliation: Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, CA, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Huang
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: brucelee@jhu.edu.
authors.forename: B Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D015780:Carbapenems / Q000494:pharmacology*; D003198:Computer Simulation; D017281:Cost of Illness; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D018803:Models, Economic; D009010:Monte Carlo Method; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: CRE; Carbapenem-resistant Enterobacteriaceae; Cost; Economic burden; Model