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Am J Infect Control. 2018 Mar;46(3):291-296. doi: 10.1016/j.ajic.2017.09.003. Epub 2017 Nov 2.

Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis.

Author information

1
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: joyceyou@cuhk.edu.hk.
2
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
3
Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

Abstract

BACKGROUND:

Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU).

METHODS:

Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results.

RESULTS:

Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold.

CONCLUSIONS:

Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved.

KEYWORDS:

Carbapenems; Enterobacteriaceae; cost-benefit analysis; decontamination; drug resistance; intensive care units

PMID:
29103639
DOI:
10.1016/j.ajic.2017.09.003
[Indexed for MEDLINE]

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