Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis - 01/03/18
, Hong-kiu Li, BPharm a, Margaret Ip, BM, MSc, DTM&H, FRCPath, FRCP(Glasg), FRCPA, FHKCPath (Clin Micro Infection), FHKAM bHighlights |
• | Selective digestive decontamination (SDD) reduces carbapenem-resistant Enterobacteriaceae (CRE) infection and mortality rate. |
• | A model-based analysis shows SDD of CRE at the intensive care unit is highly cost-effective. |
• | Sensitivity analysis finds SDD to be effective and cost-saving. |
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.
Le texte complet de cet article est disponible en PDF.Key Words : Carbapenems, drug resistance, Enterobacteriaceae, decontamination, intensive care units, cost-benefit analysis
Plan
| Conflicts of interest: None to report. |
Vol 46 - N° 3
P. 291-296 - mars 2018 Retour au numéro
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