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

Author

Listed:
  • 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

Abstract

Background: A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of “bundling” these strategies together. Methods: 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. Results: 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. Conclusions: 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.

Suggested Citation

  • 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, 2016. "An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-16, March.
    • Handle: RePEc:plo:pone00:0152248
    DOI: 10.1371/journal.pone.0152248
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    References listed on IDEAS

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    2. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    3. Richard Pitman & David Fisman & Gregory S. Zaric & Maarten Postma & Mirjam Kretzschmar & John Edmunds & Marc Brisson, 2012. "Dynamic Transmission Modeling," Medical Decision Making, , vol. 32(5), pages 712-721, September.
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    1. David Brain & Laith Yakob & Adrian Barnett & Thomas Riley & Archie Clements & Kate Halton & Nicholas Graves, 2018. "Economic evaluation of interventions designed to reduce Clostridium difficile infection," PLOS ONE, Public Library of Science, vol. 13(1), pages 1-15, January.

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