万古霉素耐药肠球菌（VRE）在综合内科病房的筛查和隔离：成本效益分析。
Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis.
机构信息
1Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON M5T 3M6 Canada.
2Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, 200 Elizabeth Street, 10th Floor, Room 247, Toronto, ON M5G 2C4 Canada.
出版信息
Antimicrob Resist Infect Control. 2019 Oct 29;8:168. doi: 10.1186/s13756-019-0628-x. eCollection 2019.
BACKGROUND
Vancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective.
METHODS
We developed a microsimulation model using local data and VRE literature, to simulate a 20-bed general medicine ward at a tertiary-care hospital with up to 1000 admissions, approximating 1 year. Primary outcomes were accrued over the patient's lifetime, discounted at 1.5%, and included expected health outcomes (VRE colonisations, VRE infections, VRE-related bacteremia, and deaths subsequent to VRE infection), quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess parameter uncertainty.
RESULTS
In our base-case analysis, VRE screening and isolation prevented six healthcare-associated VRE colonisations per 1000 admissions (6/1000), 0.6/1000 VRE-related infections, 0.2/1000 VRE-related bacteremia, and 0.1/1000 deaths subsequent to VRE infection. VRE screening and isolation accrued 0.0142 incremental QALYs at an incremental cost of $112, affording an ICER of $7850 per QALY. VRE screening and isolation practice was more likely to be cost-effective (> 50%) at a cost-effectiveness threshold of $50,000/QALY. Stochasticity (randomness) had a significant impact on the cost-effectiveness.
CONCLUSION
VRE screening and isolation can be cost-effective in majority of model simulations at commonly used cost-effectiveness thresholds, and is likely economically attractive in general medicine settings. Our findings strengthen the understanding of VRE prevention strategies and are of importance to hospital program planners and infection prevention and control.
背景
耐万古霉素肠球菌（VRE）是医疗保健环境中一种严重的抗微生物耐药威胁。我们从医疗保健支付方的角度评估了对普通医学病房中高定植风险患者进行 VRE 筛查和隔离与不进行 VRE 筛查和隔离相比的成本效益。
方法
我们使用本地数据和 VRE 文献开发了一个微观模拟模型，以模拟一家三级保健医院的 20 张病床普通内科病房，最多可容纳 1000 名患者，接近 1 年。主要结果是在患者的一生中累计计算，贴现率为 1.5%，包括预期的健康结果（VRE 定植、VRE 感染、VRE 相关菌血症和 VRE 感染后的死亡）、质量调整生命年（QALY）、医疗保健成本和增量成本效益比（ICER）。进行了概率敏感性分析（PSA）和情景分析以评估参数不确定性。
结果
在我们的基本案例分析中，VRE 筛查和隔离预防了每 1000 名入院患者中的 6 例（6/1000）医源性 VRE 定植、0.6/1000 例 VRE 相关感染、0.2/1000 例 VRE 相关菌血症和 0.1/1000 例 VRE 感染后死亡。VRE 筛查和隔离在增加 112 美元的成本下获得了 0.0142 个增量 QALY，ICER 为每 QALY 7850 美元。在 50000 美元/QALY 的常用成本效益阈值下，VRE 筛查和隔离的实施更有可能具有成本效益（>50%）。随机性（随机性）对成本效益有重大影响。
结论
在大多数模型模拟中，VRE 筛查和隔离在常用的成本效益阈值下是具有成本效益的，并且在普通内科环境中可能具有经济吸引力。我们的研究结果加强了对 VRE 预防策略的理解，对医院规划者和感染预防控制具有重要意义。
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