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. 2010 Jul 16;5(7):e11562.
doi: 10.1371/journal.pone.0011562.

Quantifying cost-effectiveness of controlling nosocomial spread of antibiotic-resistant bacteria: the case of MRSA

Marjan W M Wassenberg  1 , G Ardine de Wit, Ben A van Hout, Marc J M Bonten
Affiliations

Quantifying cost-effectiveness of controlling nosocomial spread of antibiotic-resistant bacteria: the case of MRSA

Marjan W M Wassenberg et al. PLoS One. .

Abstract

Background: The costs and benefits of controlling nosocomial spread of antibiotic-resistant bacteria are unknown.

Methods: We developed a mathematical algorithm to determine cost-effectiveness of infection control programs and explored the dynamical interactions between different epidemiological variables and cost-effectiveness. The algorithm includes occurrence of nosocomial infections, attributable mortality, costs and efficacy of infection control and how antibiotic-resistant bacteria affect total number of infections: do infections with antibiotic-resistant bacteria replace infections caused by susceptible bacteria (replacement scenario) or occur in addition to them (addition scenario). Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was used for illustration using observational data on S. aureus bacteremia (SAB) in our hospital (n = 189 between 2001-2004, all being methicillin-susceptible S. aureus [MSSA]).

Results: In the replacement scenario, the costs per life year gained range from 45,912 euros to 6590 euros for attributable mortality rates ranging from 10% to 50%. Using 20,000 euros per life year gained as a threshold, completely preventing MRSA would be cost-effective in the replacement scenario if attributable mortality of MRSA is > or = 21%. In the addition scenario, infection control would be cost saving along the entire range of estimates for attributable mortality.

Conclusions: Cost-effectiveness of controlling antibiotic-resistant bacteria is highly sensitive to the interaction between infections caused by resistant and susceptible bacteria (addition or replacement) and attributable mortality. In our setting, controlling MRSA would be cost saving for the addition scenario but would not be cost-effective in the replacement scenario if attributable mortality would be < 21%.

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Conflict of interest statement

Competing Interests: MJMB reports receiving advisory board fees from Ipsat Therapies, 3M, Cepheid and Novartis; consulting fees from Novartis, 3M and Bayer; and lecture fees from Cepheid, Kimberly Clark and Pfizer. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. All other authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Incremental costs and life years gained per year infection control.
In the replacement and addition scenario for estimates of attributable mortality (AM) of MRSA bacteremia, as compared to MSSA, ranging from 0% to 50%.
Figure 2
Figure 2. Costs per life year gained as a function of effectiveness of infection control policies and attributable mortality (AM).
A) In the replacement scenario. The 20,000 euro line on the vertical axis reflects the Dutch threshold value for cost-effectiveness. B) In the addition scenario.
Figure 3
Figure 3. Mixing replacement and addition scenarios.
Costs per life year gained as a function of the absolute increase in MRSA bacteremia incidence (horizontal axis) and the rate of attributable mortality of MRSA as compared to methicillin-sensitive Staphylococcus aureus (MSSA) (vertical axis) for the scenario that 50% of all S. aureus bacteremias cases are caused by MRSA.
See this image and copyright information in PMC

References

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