Grant: Travel Awards - Institute Community Support

Objective: Vancomycin-resistant enterococci (VRE) are a class of bacteria that are antibiotic-resistant and pose a serious threat in the healthcare setting. VRE screening and isolation programs are a method to prevent VRE transmission and infection. However, the value of these programs are unknown. Our study assesses the health benefits and accrued costs of VRE screening and isolation in patients at risk of VRE colonization compared to no screening and isolation from the Ontario healthcare payer perspective. Methods: We developed a computer-based model incorporating VRE transmission based on local hospital data and the literature. We compared targeted VRE screening and isolation to no prevention by modeling patients in a typical 20-bed general medicine ward at a hospital over a one-year time period. Expected health outcomes and costs were estimated for patients over their lifetime. Our primary outcomes were expected lifetime health outcomes (VRE colonizations, VRE infections, VRE-related bloodstream infections (BSI), and deaths subsequent to VRE infection), quality-adjusted life years (QALY), healthcare costs, and the incremental cost-effectiveness ratio (ICER). QALYs and costs were discounted at 1.5%. Sensitivity analyses were performed to assess parameter uncertainty. Results: The targeted VRE screening and isolation strategy prevented 234 VRE colonizations, 28 VRE infections, 5 BSIs, and 5 deaths subsequent to VRE infection per 10,000 patients, translating to an additional 134 QALYs gained. The additional cost of the program was $193,140, resulting in an ICER of $1,437 per QALY. Analysis excluding isolation room costs afforded an ICER of $101 per QALY. Sensitivity analyses showed robust cost-effectiveness findings. Conclusion: Targeted VRE screening and isolation, when compared to no VRE screening and isolation, appears to provide additional health benefits at minimal added costs, and is therefore likely to be considered economically attractive in Ontario.