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

Published online by Cambridge University Press:  19 March 2018

Sarah M. Bartsch ,
Susan S. Huang ,
James A. McKinnell ,
Kim F. Wong ,
Leslie E. Mueller ,
Loren G. Miller  and
Bruce Y. Lee
Sarah M. Bartsch
Affiliation:
Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine Health School of Medicine, Irvine, California
James A. McKinnell
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California Torrance Memorial Medical Center, Torrance, California
Kim F. Wong
Affiliation:
Center for Research Computing, University of Pittsburgh, Pittsburgh, Pennsylvania
Leslie E. Mueller
Affiliation:
Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
Bruce Y. Lee*
Affiliation:
Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
*
Address correspondence to Bruce Y. Lee, MD, MBA, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W3501, Baltimore, MD 21205 (brucelee@jhu.edu).
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Abstract

OBJECTIVE

While 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.

DESIGN

Economic analysis

SETTING

Orange County, California

METHODS

Using 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.

RESULTS

Compared 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.

CONCLUSIONS

Active 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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 5 , May 2018 , pp. 516 - 524
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

REFERENCES

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