1209. Expanding an Economic Evaluation of the Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections to Include Prevention of Gram-Negative Bacteria. (26th November 2018)

• Record Type: Journal Article
• Authors: Nelson, Richard E; Goto, Michihiko; Samore, Matthew; Jones, Makoto; Stevens, Vanessa; Evans, Martin; Schweizer, Marin; Perencevich, Eli; Rubin, Michael
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S366
• Page End: S367
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.1042
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: In October 2007, the Department of Veterans Affairs (VA) launched the National MRSA Prevention Initiative, a nationwide effort to reduce MRSA transmission through (1) universal screening, (2) contact isolation for MRSA+ patients, (3) institutional culture change that "infection prevention is everyone's business, " (4) emphasis on hand hygiene, and (5) increased infection control resources. While the initiative focused on MRSA, recent evidence suggests that it also led to a significant decrease in hospital-onset (HO) Gram-negative rod (GNR) bacteremia. The objective of this analysis was to evaluate the cost-effectiveness and the budget impact of the initiative taking into account both MRSA and GNR infections. Methods: We developed an economic model using published data on the rate of MRSA HAIs and HO-GNR bacteremia in the VA from October 2007 to September 2015, estimates of the attributable cost and mortality of these infections, and the costs associated with the intervention obtained through a microcosting approach. We explored several different assumptions for the rate of infections that would have occurred if the initiative had not been implemented. Effectiveness was measured in life-years (LYs) gained. Results: We found that during fiscal years 2008–2015, the initiative resulted in an estimated 4, 761–9, 236 fewer MRSA HAIs and 1, 447–2, 159 fewer HO-GNR bacteremia. The initiative itself was estimated to cost $206 million over this 8-year period while the cost savings from prevented MRSA HAIs ranged from $75–165 million and from prevented HO-GNR bacteremia ranged from $42–62 million. The incremental cost-effectiveness of the initiative ranged from $12, 146–$46, 500/LY when just including MRSA HAIs and from $7, 945–$24, 387/LY when including HO-GNR bacteremia. The overall impact on the VA's budget ranged from $200–$334 million. Conclusion: An MRSA surveillance and prevention strategy in VA may have prevented a substantial number of MRSA and GNR infections. The savings associated with the prevented infections helped to offset some but not all of the cost of the initiative. Economic evaluations of these interventions can help decision makers understand the trade offs between increased cost and improved health that can come from such interventions. Disclosures: All authors: No reported disclosures.