Mean cost, QALYs, and infections per 10,000 patient days by BASE, INT, and OPT.

<p>Mean cost, QALYs, and infections per 10,000 patient days by BASE, INT, and OPT.</p

Use of Concomitant Antibiotics During Treatment for Clostridium difficile Infection (CDI) in Pediatric Inpatients: An Observational Cohort Study

<p><strong>Article full text</strong></p> <p><br> The full text of this article can be found <a href="https://link.springer.com/article/10.1007/s40121-016-0105-2"><b>here</b>.</a><br> <br> <strong>Provide enhanced content for this article</strong><br> There are currently no enhanced features for this article. If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <u>[email protected]</u>.<br> <br> The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.<br> <br> Other enhanced features include, but are not limited to:</p> <p>• Summary Slides</p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p> <p> </p

Results from cost-effectiveness analysis.

<p>Results from cost-effectiveness analysis.</p

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

<div><p>Background</p><p>A number of strategies exist to reduce <i>Clostridium difficile</i> (<i>C</i>. <i>difficile</i>) transmission. We conducted an economic evaluation of “bundling” these strategies together.</p><p>Methods</p><p>We constructed an agent-based computer simulation of nosocomial <i>C</i>. <i>difficile</i> transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via <i>C</i>. <i>difficile</i> shedding; <i>C</i>. <i>difficile</i> hand carriage and removal via hand hygiene; patient acquisition of <i>C</i>. <i>difficile</i> via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive <i>C</i>. <i>difficile</i> 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 <i>C</i>. <i>diff</i> 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 <i>C</i>. <i>difficile</i> importation prevalence and transmissibility of <i>C</i>. <i>difficile</i>.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>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 <i>C</i>. <i>difficile</i> importation prevalence and transmissibility.</p></div

Scatterplot of incremental cost and effectiveness (<i>C</i>. <i>difficile</i> infections averted) of intervention strategies compared with INT levels of all 6 bundle components.

<p>HAND: dark gray = INT, black = OPT; DCON: triangle = INT, square = OPT.</p

Key parameter inputs to simulation model.

<p>Key parameter inputs to simulation model.</p

Cost and utility parameters.

<p>Cost and utility parameters.</p

Cost-effectiveness acceptability curves depicting the probability that BASE, INT, and OPT strategies are cost-effective across different threshold values of willingness to pay from 195 2^nd order Monte Carlo simulations.

<p>Cost-effectiveness acceptability curves depicting the probability that BASE, INT, and OPT strategies are cost-effective across different threshold values of willingness to pay from 195 2^nd order Monte Carlo simulations.</p