Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

Sarkis Manoukian; Sally Stewart; Stephanie J. Dancer; Helen Mason; Nicholas Graves; Chris Robertson; Alistair Leonard; Sharon Kennedy; Kim Kavanagh; Benjamin Parcell; Jacqui Reilly

doi:10.1007/s10198-021-01419-5

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

Sarkis Manoukian (Lead / Corresponding author), Sally Stewart, Stephanie J. Dancer, Helen Mason, Nicholas Graves, Chris Robertson, Alistair Leonard, Sharon Kennedy, Kim Kavanagh, Benjamin Parcell, Jacqui Reilly

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

53 Downloads (Pure)

Abstract

Background: Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.

Objective: We assess the relative cost-effectiveness of screening programmes compared with no- screening.

Methods: A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.

Results: In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.

Conclusion: The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.

Original language	English
Pages (from-to)	1173-1185
Number of pages	13
Journal	European Journal of Health Economics
Volume	23
Early online date	21 Dec 2021
DOIs	https://doi.org/10.1007/s10198-021-01419-5
Publication status	Published - 21 Dec 2021

Keywords

Health economics
Screening programmes
Healthcare-associated infection
Carbapenemase-producing-Enterobacteriaceae
Microsimulation
National Health Service

Access to Document

10.1007/s10198-021-01419-5Licence: CC BY

Final Published VersionFinal published version, 893 KBLicence: CC BY

Cite this

Manoukian, S., Stewart, S., Dancer, S. J., Mason, H., Graves, N., Robertson, C., Leonard, A., Kennedy, S., Kavanagh, K., Parcell, B., & Reilly, J. (2021). Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom. European Journal of Health Economics, 23, 1173-1185. https://doi.org/10.1007/s10198-021-01419-5

@article{0c98c9b4857a4abcbf4a6fd696215c20,

title = "Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom",

abstract = "Background: Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.Objective: We assess the relative cost-effectiveness of screening programmes compared with no- screening.Methods: A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.Results: In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.Conclusion: The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.",

keywords = "Health economics, Screening programmes, Healthcare-associated infection, Carbapenemase-producing-Enterobacteriaceae, Microsimulation, National Health Service",

author = "Sarkis Manoukian and Sally Stewart and Dancer, {Stephanie J.} and Helen Mason and Nicholas Graves and Chris Robertson and Alistair Leonard and Sharon Kennedy and Kim Kavanagh and Benjamin Parcell and Jacqui Reilly",

note = "Funding - Health Protection Scotland (RIE reference 14-154) {\textcopyright} 2021. The Author(s).",

year = "2021",

month = dec,

day = "21",

doi = "10.1007/s10198-021-01419-5",

language = "English",

volume = "23",

pages = "1173--1185",

journal = "European Journal of Health Economics",

issn = "1618-7598",

publisher = "Springer Verlag",

}

Manoukian, S, Stewart, S, Dancer, SJ, Mason, H, Graves, N, Robertson, C, Leonard, A, Kennedy, S, Kavanagh, K, Parcell, B & Reilly, J 2021, 'Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom', European Journal of Health Economics, vol. 23, pp. 1173-1185. https://doi.org/10.1007/s10198-021-01419-5

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom. / Manoukian, Sarkis (Lead / Corresponding author); Stewart, Sally; Dancer, Stephanie J. et al.
In: European Journal of Health Economics, Vol. 23, 21.12.2021, p. 1173-1185.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

AU - Manoukian, Sarkis

AU - Stewart, Sally

AU - Dancer, Stephanie J.

AU - Mason, Helen

AU - Graves, Nicholas

AU - Robertson, Chris

AU - Leonard, Alistair

AU - Kennedy, Sharon

AU - Kavanagh, Kim

AU - Parcell, Benjamin

AU - Reilly, Jacqui

PY - 2021/12/21

Y1 - 2021/12/21

N2 - Background: Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.Objective: We assess the relative cost-effectiveness of screening programmes compared with no- screening.Methods: A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.Results: In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.Conclusion: The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.

AB - Background: Antimicrobial resistance has been recognised as a global threat with carbapenemase- producing-Enterobacteriaceae (CPE) as a prime example. CPE has similarities to COVID-19 where asymptomatic patients may be colonised representing a source for onward transmission. There are limited treatment options for CPE infection leading to poor outcomes and increased costs. Admission screening can prevent cross-transmission by pre-emptively isolating colonised patients.Objective: We assess the relative cost-effectiveness of screening programmes compared with no- screening.Methods: A microsimulation parameterised with NHS Scotland date was used to model scenarios of the prevalence of CPE colonised patients on admission. Screening strategies were (a) two-step screening involving a clinical risk assessment (CRA) checklist followed by microbiological testing of high-risk patients; and (b) universal screening. Strategies were considered with either culture or polymerase chain reaction (PCR) tests. All costs were reported in 2019 UK pounds with a healthcare system perspective.Results: In the low prevalence scenario, no screening had the highest probability of cost-effectiveness. Among screening strategies, the two CRA screening options were the most likely to be cost-effective. Screening was more likely to be cost-effective than no screening in the prevalence of 1 CPE colonised in 500 admitted patients or more. There was substantial uncertainty with the probabilities rarely exceeding 40% and similar results between strategies. Screening reduced non-isolated bed-days and CPE colonisation. The cost of screening was low in relation to total costs.Conclusion: The specificity of the CRA checklist was the parameter with the highest impact on the cost-effectiveness. Further primary data collection is needed to build models with less uncertainty in the parameters.

KW - Health economics

KW - Screening programmes

KW - Healthcare-associated infection

KW - Carbapenemase-producing-Enterobacteriaceae

KW - Microsimulation

KW - National Health Service

U2 - 10.1007/s10198-021-01419-5

DO - 10.1007/s10198-021-01419-5

M3 - Article

C2 - 34932169

SN - 1618-7598

VL - 23

SP - 1173

EP - 1185

JO - European Journal of Health Economics

JF - European Journal of Health Economics

ER -

Probabilistic microsimulation to examine the cost-effectiveness of hospital admission screening strategies for carbapenemase-producing enterobacteriaceae (CPE) in the United Kingdom

Abstract

Keywords

Access to Document

Fingerprint

Cite this