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Gordon LG, Elliott TM, Forde B, Mitchell B, Russo PL, Paterson DL, Harris PNA. Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia. BMJ Open 2021; 11:e041968. [PMID: 33526501 PMCID: PMC7852923 DOI: 10.1136/bmjopen-2020-041968] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care. DESIGN Budget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends. SETTING Queensland, Australia. PARTICIPANTS Hospitalised patients. INTERVENTIONS WGS surveillance of six common multidrug-resistant organisms (Staphylococcus aureus, Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterobacter sp and Acinetobacter baumannii) compared with standard of care or routine microbiology testing. PRIMARY AND SECONDARY OUTCOMES Expected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections. RESULTS In 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits. CONCLUSIONS Compared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.
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Affiliation(s)
- Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Thomas M Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Brian Forde
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Brett Mitchell
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Philip L Russo
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - David L Paterson
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
- Pathology Queensland, Queensland Health, Brisbane, Queensland, Australia
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White NM, Barnett AG, Hall L, Mitchell BG, Farrington A, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Gericke CA, Graves N. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections. Clin Infect Dis 2020; 70:2461-2468. [PMID: 31359053 PMCID: PMC7286366 DOI: 10.1093/cid/ciz717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016-2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. METHODS A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. RESULTS Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. CONCLUSIONS A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Lisa Hall
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
- School of Public Health, University of Queensland, Brisbane, Western Australia
| | - Brett G Mitchell
- Discipline of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Western Australia
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Western Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Kate Halton
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Crawley, Western Australia
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
- School of Veterinary and Life Sciences, Murdoch University, Western Australia,, Cairns, Queensland, Australia
| | - Anne Gardner
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Katie Page
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Christian A Gericke
- School of Clinical Medicine, University of Queensland, Cairns, Queensland, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, and College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
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Health and economic burden of antimicrobial-resistant infections in Australian hospitals: a population-based model. Infect Control Hosp Epidemiol 2020; 40:320-327. [PMID: 30887942 DOI: 10.1017/ice.2019.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate the additional health and economic burden of antimicrobial-resistant (AMR) infections in Australian hospitals. METHODS A simulation model based on existing evidence was developed to assess the additional mortality and costs of healthcare-associated AMR Escherichia coli (E. coli), Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecium, and Staphylococcus aureus infections. SETTING Australian public hospitals. FINDINGS Australian hospitals spent an additional AUD$5.8 million (95% uncertainty interval [UI], $2.2-$11.2 million) per year treating ceftriaxone-resistant E.coli bloodstream infections (BSI), and an estimated AUD$5.5 million per year (95% UI, $339,633-$22.7 million) treating MRSA patients. There are no reliable estimates of excess morbidity and mortality from AMR infections in sites other than the blood and in particular for highly prevalent AMR E. coli causing urinary tract infections (UTIs). CONCLUSION The limited evidence-base of the health impact of resistant infection in UTIs limits economic studies estimating the overall burden of AMR. Such data are increasingly important and are urgently needed to support local clinical practice as well as national and global efforts to curb the spread of AMR.
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