The Economic Value of the Centers for Disease Control and Prevention Carbapenem-Resistant Enterobacteriaceae Toolkit

Abstract

OBJECTIVEWhile previous work showed that the Centers for Disease Control and Prevention toolkit for carbapenem-resistant Enterobacteriaceae (CRE) can reduce spread regionally, these interventions are costly, and decisions makers want to know whether and when economic benefits occur.DESIGNEconomic analysisSETTINGOrange County, CaliforniaMETHODSUsing our Regional Healthcare Ecosystem Analyst (RHEA)-generated agent-based model of all inpatient healthcare facilities, we simulated the implementation of the CRE toolkit (active screening of interfacility transfers) in different ways and estimated their economic impacts under various circumstances.RESULTSCompared to routine control measures, screening generated cost savings by year 1 when hospitals implemented screening after identifying ≤20 CRE cases (saving $2,000-$9,000) and by year 7 if all hospitals implemented in a regional coordinated manner after 1 hospital identified a CRE case (hospital perspective). Cost savings was achieved only if hospitals independently screened after identifying 10 cases (year 1, third-party payer perspective). Cost savings was achieved by year 1 if hospitals independently screened after identifying 1 CRE case and by year 3 if all hospitals coordinated and screened after 1 hospital identified 1 case (societal perspective). After a few years, all strategies cost less and have positive health effects compared to routine control measures; most strategies generate a positive cost-benefit each year.CONCLUSIONSActive screening of interfacility transfers garnered cost savings in year 1 of implementation when hospitals acted independently and by year 3 if all hospitals collectively implemented the toolkit in a coordinated manner. Despite taking longer to manifest, coordinated regional control resulted in greater savings over time.Infect Control Hosp Epidemiol 2018;39:516-524.

FIGURE 1

Cumulative cost savings of carbapenem-resistant Enterobacteriaceae (CRE) control measures with various triggers compared to routine control measures (A) from the hospital perspective, (B) from the third-party payer perspective, and (C) from the societal perspective. The model assumes a base case of 5% probability of infection and 35% attributable mortality.

FIGURE 2

The impact of parameters varied in sensitivity analyses on uncoordinated and coordinated approaches with a trigger of 10 from (A) the hospital perspective with an uncoordinated approach, (B) the hospital perspective with a coordinated approach, (C) the third-party payer perspective with an uncoordinated approach, (D) the third-party payer perspective with a coordinated approach, (E) the societal perspective with an uncoordinated approach, and (F) the societal perspective with a coordinated approach. The vertical line shows the total cost over 10 years when all parameters on the y-axis are held at their midpoint values. The width of the bar represents the variability in total cost when the parameter is ranged from its minimum to maximum.

FIGURE 3

Cost-benefit over time compared to no specific carbapenem-resistant Enterobacteriaceae control measures from the societal perspective (5% probability of infection; 35% attributable mortality).