Abstract
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.
Original language | English |
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Pages (from-to) | 1173-1185 |
Number of pages | 13 |
Journal | European Journal of Health Economics |
Volume | 23 |
Issue number | 7 |
Early online date | 21 Dec 2021 |
DOIs | |
Publication status | Published - Sept 2022 |
Keywords
- health economics
- screening programmes
- healthcare-associated infection
- Carbapenemase-producing Enterobacteriaceae
- microsimulation
- National Health Service
- Screening programmes
- Health Economics
- Healthcare-associated infection
- Microsimulation
- Carbapenemase-producing-Enterobacteriaceae
ASJC Scopus subject areas
- Economics, Econometrics and Finance (miscellaneous)
- Health Policy