Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom.

Autor: Manoukian S; Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK. sarkis.manoukian@gcu.ac.uk., Stewart S; Safeguarding Health Through Infection Prevention Research Group, Glasgow Caledonian University, Glasgow, Scotland, UK., Dancer SJ; Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire and School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland, UK., Mason H; Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK., Graves N; Duke-NUS Medical School, Singapore, Singapore., Robertson C; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK., Leonard A; NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK., Kennedy S; Information Services Division, Public Health Scotland, Edinburgh, Scotland, UK., Kavanagh K; Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK., Parcell B; Medical Microbiology, NHS Tayside, Ninewells Hospital and School of Medicine, Dundee, Scotland, UK., Reilly J; Safeguarding Health Through Infection Prevention Research Group, Glasgow Caledonian University, Glasgow, Scotland, UK.
Jazyk: angličtina
Zdroj: The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2022 Sep; Vol. 23 (7), pp. 1173-1185. Date of Electronic Publication: 2021 Dec 21.
DOI: 10.1007/s10198-021-01419-5
Abstrakt: Background: Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.
Objective: We assess the relative cost-effectiveness of screening programmes compared with no- screening.
Methods: A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.
Results: In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.
Conclusion: The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.
(© 2021. The Author(s).)
Databáze: MEDLINE
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