OBJECTIVES: The prevalence of carbapenem-resistant Enterobacteriaceae(CRE) has been increasing and proactive surveillance is highly recommended. Patients in intensive care unit (ICU) are particularly prone to CRE acquisition due to multiple risk factors. The objective of this study was to examine the potential cost and clinical outcomes of active CRE surveillance upon ICU admission from the perspective of healthcare providers in Hong Kong. METHODS: A Markov model was designed to compare the outcomes of active CRE surveillance versus no active surveillance in patients admitted to an ICU in Hong Kong. CRE-associated direct medical cost and CRE-associated quality-adjusted life years (QALYs) loss were simulated based on the model inputs derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of the results. RESULTS: In the base-case analysis, active surveillance group showed less QALYs loss (0.3335 vs 0.3827) with higher CRE-associated cost (HKD9,825 vs HKD9,800) (USD1=HKD7.8) than control group. The incremental cost-effectiveness ratio (ICER) of active surveillance was HKD 500 per QALY saved compared to control group. Sensitivity analysis found base-case results robust to variation of all model inputs. In 10,000 Monte Carlo simulations, active surveillance group was less costly by HKD1,064 per patient (95%CI HKD1,025-1,103; p<0.001) and lower mean QALYs loss by 0.430 (95% CI, 0.422-0.438; p < 0.001) when compared with control group. ICERs per QALY saved by the active surveillance group were less than the gross domestic product per capita in Hong Kong (HKD330,113) in 99.98% of the simulations. CONCLUSIONS: Active CRE surveillance upon ICU admission appears to be a cost-effective strategy from the perspective of healthcare providers in Hong Kong.