Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units: Is it cost-effective in a nonendemic region?

Objective Carbapenem-resistant Enterobacteriaceae (CRE) cause significant morbidity and mortality in intensive care unit (ICU) settings. We examined potential cost-effectiveness of active CRE surveillance at ICUs in a nonendemic region from the perspective of a Hong Kong health care provider. Methods A decision analytic model was designed to simulate outcomes of active CRE surveillance in ICUs. Outcome measures included CRE-associated direct medical cost, infection rate, mortality rate, quality-adjusted life year (QALY) loss, and incremental cost per QALY saved by active surveillance. Model inputs were derived from the literature. Sensitivity analyses evaluated the influence of uncertainty of model variables. Results In base-case analysis, the surveillance group was more costly ($1,260 vs $1,256) with lower CRE infection rate (5.670% vs 5.902%), CRE-associated mortality rate (2.139% vs 2.455%), and CRE-associated QALY loss (0.3335 vs 0.3827) than the control group. Incremental cost per QALY saved of active surveillance was $81 per QALY saved. One-way sensitivity analyses found base-case results to be robust to a variety of model inputs. In 10,000 Monte Carlo simulations, the surveillance group was the preferred option 99.98% of time. Conclusions Active CRE surveillance in ICUs appears to be highly cost-effective to reduce CRE infection rate, mortality rate, and QALY loss in a low CRE burden region.