An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model

Richard E Nelson; Makoto Jones; Molly Leecaster; Matthew H Samore; William Ray; Angela Huttner; Benedikt Huttner; Karim Khader; Vanessa W Stevens; Dale Gerding; Marin L Schweizer; Michael A Rubin

doi:10.1371/journal.pone.0152248

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An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model

Journal article

Open access

Peer reviewed

An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model

Richard E Nelson, Makoto Jones, Molly Leecaster, Matthew H Samore, William Ray, Angela Huttner, Benedikt Huttner, Karim Khader, Vanessa W Stevens, Dale Gerding, …

PloS one, Vol.11(3), pp.e0152248-e0152248

2016

DOI: 10.1371/journal.pone.0152248

PMCID: PMC4816545

PMID: 27031464

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Abstract

A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of "bundling" these strategies together. We constructed an agent-based computer simulation of nosocomial C. difficile transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive C. difficile testing; (b) empiric isolation and treatment of symptomatic patients; (c) improved adherence to hand hygiene and (d) contact precautions; (e) improved use of soap and water for hand hygiene; and (f) improved environmental cleaning. Our analysis compared these interventions using values representing 3 different scenarios: (1) base-case (BASE) values that reflect typical hospital practice, (2) intervention (INT) values that represent implementation of hospital-wide efforts to reduce C. diff transmission, and (3) optimal (OPT) values representing the highest expected results from strong adherence to the interventions. Cost parameters for each intervention were obtained from published literature. We performed our analyses assuming low, normal, and high C. difficile importation prevalence and transmissibility of C. difficile. INT levels of the "bundled" intervention were cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in all importation prevalence and transmissibility scenarios. OPT levels of intervention were cost-effective for normal and high importation prevalence and transmissibility scenarios. When analyzed separately, hand hygiene compliance, environmental decontamination, and empiric isolation and treatment were the interventions that had the greatest impact on both cost and effectiveness. A combination of available interventions to prevent CDI is likely to be cost-effective but the cost-effectiveness varies for different levels of intensity of the interventions depending on epidemiological conditions such as C. difficile importation prevalence and transmissibility.

Cross Infection - prevention & control

Humans

Hand Hygiene - economics

Clostridium difficile - isolation & purification

Models, Economic

Infection Control - methods

Soaps - economics

Cross Infection - transmission

Soaps - therapeutic use

Hospitals

Computer Simulation

Cost-Benefit Analysis

Cross Infection - diagnosis

Hand Hygiene - methods

Enterocolitis, Pseudomembranous - prevention & control

Enterocolitis, Pseudomembranous - diagnosis

Enterocolitis, Pseudomembranous - transmission

Infection Control - economics

Details

Title: Subtitle: An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model
Creators: Richard E Nelson - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Makoto Jones - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Molly Leecaster - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Matthew H Samore - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
William Ray - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Angela Huttner - Infection Control Program, Geneva Hospitals, Geneva, Switzerland
Benedikt Huttner - Infection Control Program, Geneva Hospitals, Geneva, Switzerland
Karim Khader - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Vanessa W Stevens - Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America
Dale Gerding - Edward Hines Jr. VA Hospital, Hines, IL, United States of America
Marin L Schweizer - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, United States of America
Michael A Rubin - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
Resource Type: Journal article
Publication Details: PloS one, Vol.11(3), pp.e0152248-e0152248
DOI: 10.1371/journal.pone.0152248
PMID: 27031464
PMCID: PMC4816545
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: Public Library of Science
Grant note: 07FED706506 / PHS HHS
Language: English
Date published: 2016
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094567402771

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