Lapointe-Shaw L, Voruganti T, Kohler P, Thein H-H, Sander B, McGeer A
Department of Medicine, University of Toronto, Toronto, Canada.
Toronto General Hospital, 14 EN room 213, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada.
Eur J Clin Microbiol Infect Dis. 2017 Jun;36(6):1047-1055. doi: 10.1007/s10096-016-2890-7. Epub 2017 Jan 11.
The purpose of this study was to assess the cost-effectiveness of screening all hospital inpatients for carbapenemase-producing Enterobacteriaceae (CPE) at the time of hospital admission, compared to not screening, from a US hospital perspective. We used a linked transmission/Markov model to compare outcomes for a typical hospitalized medical patient, from a community with a colonization prevalence of 0.05%. Outcomes were number of colonized patients, CPE-related clinical infections and deaths, expected quality-adjusted life years (QALYs), cost, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to assess the effect of parameter uncertainty, using a willingness-to-pay threshold of $100,000 per QALY gained. Screening prevented six CPE colonization cases per 1000 patients (1/1000 colonized with screening, 7/1000 without screening), over half of all symptomatic CPE infections (2/10,000 symptomatic with screening, 5/10,000 symptomatic without screening), and nearly half of all CPE-related deaths (8/100,000 deaths with screening, 15/100,000 deaths without screening). Screening accrued 0.0009 additional QALYs and cost an additional $24.68, compared to not screening, and was cost-effective (ICER $26,283 per QALY gained). Our results were sensitive to uncertainty in prevalence and the number of secondary colonizations per colonized patient. Screening was not cost-effective at a prevalence below 0.015% or if transmission to fewer than 0.9 new patients occurred for each colonized patient. At prevalence levels above 0.3%, screening was cost-saving compared to not screening. Screening inpatients for CPE carriage is likely cost-effective, and may be cost-saving, depending on the local prevalence of carriage.
本研究的目的是从美国医院的角度评估，与不进行筛查相比，在入院时对所有住院患者筛查产碳青霉烯酶肠杆菌科细菌（CPE）的成本效益。我们使用了一个关联传播/马尔可夫模型，来比较来自定植患病率为0.05%社区的典型住院内科患者的结局。结局指标包括定植患者数量、CPE相关临床感染和死亡人数、预期质量调整生命年（QALY）、成本以及增量成本效益比（ICER）。进行了敏感性分析，以评估参数不确定性的影响，采用每获得一个QALY支付意愿阈值为100,000美元。筛查可预防每1000名患者中有6例CPE定植病例（筛查时1/1000定植，不筛查时7/1000），超过一半的所有有症状CPE感染（筛查时有症状的为2/10,000，不筛查时有症状的为5/10,000），以及近一半的所有CPE相关死亡（筛查时死亡8/100,000，不筛查时死亡15/100,000）。与不筛查相比，筛查可增加0.0009个QALY，额外成本为24.68美元，且具有成本效益（每获得一个QALY的ICER为26,283美元）。我们的结果对患病率和每名定植患者的二次定植数量的不确定性敏感。在患病率低于0.015%或每名定植患者传播给少于0.9名新患者的情况下，筛查不具有成本效益。在患病率高于0.3%时，与不筛查相比，筛查可节省成本。对住院患者进行CPE携带筛查可能具有成本效益，并且根据当地携带率情况可能节省成本。
