title: Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective.
abstract: OBJECTIVE
  To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE).
  
  
  METHODS
  We performed an observational economic evaluation of an outbreak of CPE (NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and 'opportunity cost' (staff time, bed closures and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10-month duration of the outbreak.
  
  
  RESULTS
  The outbreak cost €1.1m over 10 months (range €0.9-1.4m), comprising €312 000 actual expenditure, and €822 000 (range €631 000-€1.1m) in opportunity cost. An additional €153 000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54 000 on anti-infectives for 18 patients treated, €94 000 on laboratory costs for screening, €73 000 on contact precautions for 1831 contact precautions patient-days, €42 000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43 000 on 2592 hours of ward-based monitors, and €6000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244 000 related to 1206 lost bed-days (range 366-2562 bed-days, €77 000-€512 000), €349 000 in missed revenue from 72 elective surgical procedures, and €228 000 in staff time (range €205 000-€251 000). Reduced capacity to perform elective surgical procedures related to bed closures (€349 000) represented the greatest cost.
  
  
  CONCLUSIONS
  The cost estimates that we present suggest that CPE outbreaks are highly costly.
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK. Electronic address: jon.otter@imperial.nhs.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Otter
authors.affiliation: Department of Health, Global and Public Health Group, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Burgess
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Davies
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mookerjee
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Singleton
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gilchrist
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Parsons
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK.
authors.forename: E T
authors.initials: ET
authors.lastname: Brannigan
authors.affiliation: Public Health England (PHE), AMRS & HCAI Programme, National Infection Service, London, UK; Imperial College London, NIHR Health Protection Research Unit, Hammersmith Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Robotham
authors.affiliation: Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK; Imperial College London, NIHR Health Protection Research Unit, Hammersmith Hospital, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D001426:Bacterial Proteins / Q000378:metabolism*; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks / Q000191:economics*; D017721:Hospital Costs; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D008131:London / Q000453:epidemiology; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenem; Carbapenem-resistant Enterobacteriaceae; Carbapenemase-producing Enterobacteriaceae; Cost; Economic evaluation; Klebsiella pneumoniae; New Delhi metallo-β-lactamase; Outbreak