Clinical and Economic Outcomes of Genome Sequencing Availability on Containing a Hospital Outbreak of Resistant Escherichia coli in Australia

Aug 1, 2020, 00:00
10.1016/j.jval.2020.03.006
https://www.valueinhealthjournal.com/article/S1098-3015(20)30183-2/fulltext
Title : Clinical and Economic Outcomes of Genome Sequencing Availability on Containing a Hospital Outbreak of Resistant Escherichia coli in Australia
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(20)30183-2&doi=10.1016/j.jval.2020.03.006
First page : 994
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 994

Objectives

To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak.

Methods

We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty.

Results

An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054).

Conclusions

Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Economic Evaluation
  • Infectious Disease
  • Methodological & Statistical Research
  • Modeling and simulation
  • Specific Diseases & Conditions
Tags :
  • agent-based modeling
  • bacterial infectious disease
  • cost consequences
  • discrete event modeling
  • healthcare associated infections
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