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.

中文翻译：

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普通科病房中耐万古霉素的肠球菌（VRE）的筛选和分离：成本效益分析。

背景耐万古霉素的肠球菌（VRE）在医疗机构中是严重的耐药菌威胁。我们从普通医疗病房评估了高风险定植患者的VRE筛查和隔离的成本效益，而从医疗保健支付者的角度来看，没有VRE筛查和隔离的成本效益。方法我们利用当地数据和VRE文献开发了一个微观模拟模型，以模拟一家三级医院的20张病床的普通病房，最多可容纳1000名患者，大约1年。主要结局指标在患者的一生中累计，折现率为1.5％，其中包括预期的健康结局（VRE定植，VRE感染，VRE相关菌血症以及VRE感染后死亡），质量调整生命年（QALYs），医疗保健费用，以及成本效益比（ICER）。进行了概率敏感性分析（PSA）和方案分析，以评估参数不确定性。结果在我们的基本病例分析中，VRE筛选和分离预防了每1000例入院（6/1000），0.6 / 1000 VRE相关感染，0.2 / 1000 VRE相关菌血症和0.1 / 1000例死亡导致6例与医疗相关的VRE定植到VRE感染。VRE筛选和隔离产生了0.0142个增量QALY，增量成本为112美元，每个QALY的ICER为7850美元。VRE筛查和隔离实践更有可能具有成本效益（> 50％），成本效益阈值为50,000美元/ QALY。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，在常用的成本效益阈值下，VRE筛查和隔离可能具有成本效益，并且在一般医学环境中可能具有经济吸引力。我们的发现加深了对VRE预防策略的理解，对医院规划人员和感染预防与控制非常重要。