title: Cost-effectiveness analysis of universal screening for carbapenemase-producing Enterobacteriaceae in hospital inpatients.
abstract: The purpose of this study was to assess the cost-effectiveness of screening all hospital inpatients for carbapenemase-producing Enterobacteriaceae (CPE) at the time of hospital admission, compared to not screening, from a US hospital perspective. We used a linked transmission/Markov model to compare outcomes for a typical hospitalized medical patient, from a community with a colonization prevalence of 0.05%. Outcomes were number of colonized patients, CPE-related clinical infections and deaths, expected quality-adjusted life years (QALYs), cost, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to assess the effect of parameter uncertainty, using a willingness-to-pay threshold of $100,000 per QALY gained. Screening prevented six CPE colonization cases per 1000 patients (1/1000 colonized with screening, 7/1000 without screening), over half of all symptomatic CPE infections (2/10,000 symptomatic with screening, 5/10,000 symptomatic without screening), and nearly half of all CPE-related deaths (8/100,000 deaths with screening, 15/100,000 deaths without screening). Screening accrued 0.0009 additional QALYs and cost an additional $24.68, compared to not screening, and was cost-effective (ICER $26,283 per QALY gained). Our results were sensitive to uncertainty in prevalence and the number of secondary colonizations per colonized patient. Screening was not cost-effective at a prevalence below 0.015% or if transmission to fewer than 0.9 new patients occurred for each colonized patient. At prevalence levels above 0.3%, screening was cost-saving compared to not screening. Screening inpatients for CPE carriage is likely cost-effective, and may be cost-saving, depending on the local prevalence of carriage.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Canada. lauren.lapointe.shaw@mail.utoronto.ca.|Toronto General Hospital, 14 EN room 213, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada. lauren.lapointe.shaw@mail.utoronto.ca.
authors.forename: L
authors.identifier: http://orcid.org/0000-0003-4485-6719
authors.initials: L
authors.lastname: Lapointe-Shaw
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Voruganti
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Kohler
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors.forename: H-H
authors.initials: HH
authors.lastname: Thein
authors.affiliation: Public Health Ontario, Toronto, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Sander
authors.affiliation: Sinai Health System, Toronto, Canada.
authors.forename: A
authors.initials: A
authors.lastname: McGeer
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000302:isolation & purification*; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D007297:Inpatients; D008403:Mass Screening / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*