Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore.
J Hosp Infect. 2024 Jan;143:178-185. doi: 10.1016/j.jhin.2023.09.010. Epub 2023 Sep 27.
An infection surveillance system based on a hospital's digital twin [4D-Disease Outbreak Surveillance System (4D-DOSS)] is being developed in Singapore. It offers near-real-time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D-DOSS.
A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D-DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed.
In the base-case scenario, with 10-year implementation/maintenance costs of 4D-DOSS of $0, there was 68.6% chance that 4D-DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D-DOSS in reducing MRSA transmission was one-quarter of the base-case scenario with 10-year implementation/maintenance costs of $1 million, there was 47.7% chance that adoption of 4D-DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty.
This early-stage modelling study revealed the circumstances for which 4D-DOSS is likely to be cost-effective at the current willingness-to-pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug-resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D-DOSS.
新加坡正在开发一种基于医院数字孪生的感染监测系统[4D-疾病爆发监测系统（4D-DOSS）]。它提供近乎实时的感染监测和映射功能。本项早期经济建模研究以耐甲氧西林金黄色葡萄球菌（MRSA）为研究对象，旨在评估 4D-DOSS 用于 MRSA 监测的潜在成本效益。
我们开发了一个马尔可夫模型来模拟 MRSA 定植和感染的可能性，以从医院角度评估采用 4D-DOSS 进行 MRSA 监测相对于当前实践的成本效益。该模型的周期持续时间为 1 天，模型的时间范围为 30 天。我们进行了概率敏感性分析，并报告了成本效益的概率。此外，我们还进行了情景分析和信息价值分析。
在基本情况下，4D-DOSS 的 10 年实施/维护成本为 0，那么 4D-DOSS 具有 68.6%的可能性具有成本效益。在更悲观但合理的情况下，假设 4D-DOSS 降低 MRSA 传播的有效性仅是基本情况的四分之一，且 10 年实施/维护成本为 100 万美元，那么 4D-DOSS 的采用具有 47.7%的可能性具有成本效益。信息价值分析表明，MRSA 成本的不确定性对模型不确定性的贡献最大。
本项早期建模研究揭示了在当前支付意愿阈值下 4D-DOSS 可能具有成本效益的情况，并确定了需要进一步研究以降低模型不确定性的参数。纳入其他耐药生物体将更全面地评估 4D-DOSS 的成本效益。
