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2019 HSR&D/QUERI National Conference Abstract

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1070 — Expanding an economic evaluation of the VA MRSA Prevention Initiative to include prevention of infections from other pathogens

Lead/Presenter: Richard Nelson,  COIN - Salt Lake City
All Authors: Nelson RE (Informatics, Decision Enhancement and Analytic Sciences Center,National Center on Homelessness Among Veterans, University of Utah School of Medicine), Goto M (Comprehensive Access & Delivery Research & Evaluation, University of Iowa Carver College of Medicine), Samore MH (Informatics, Decision Enhancement and Analytic Sciences Center, University of Utah School of Medicine) Jones M (Informatics, Decision Enhancement and Analytic Sciences Center, University of Utah School of Medicine) Stevens VW (Informatics, Decision Enhancement and Analytic Sciences Center, University of Utah School of Medicine) Evans ME (Lexington VA Medical Center, VA MRSA/MDRO Program, University of Kentucky School of Medicine) Schweizer ML (Comprehensive Access & Delivery Research & Evaluation, University of Iowa Carver College of Medicine) Cook J (Informatics, Decision Enhancement and Analytic Sciences Center, University of Utah School of Medicine) Rubin MA (Informatics, Decision Enhancement and Analytic Sciences Center, University of Utah School of Medicine)

Objectives:
In October 2007, the VA launched a nationwide effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission called the National MRSA Prevention Initiative. 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, vancomycin-resistant Enterococci (VRE), and Clostridium difficile infections. The objective of this analysis was to evaluate the cost-effectiveness and the budget impact of the initiative taking into account MRSA, GNR, VRE, and Clostridium difficile 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, 1,447-2,159 fewer HO-GNR bacteremia, 3,083-3,602 fewer Clostridium difficile infections, and 2,075-5,393 fewer VRE infections. The initiative itself was estimated to cost $561 million over this 8-year period while the cost savings from prevented MRSA HAIs ranged from $165-315 million and from prevented HO-GNR bacteremia, CRE and Clostridium difficile infections ranged from $174-$200 million. The incremental cost-effectiveness of the initiative ranged from $12,146-$38,673/LY when just including MRSA HAIs and from $1,354-$4,369/LY when including the additional pathogens. The overall impact on the VA's budget ranged from $67-$195 million.

Implications:
An MRSA surveillance and prevention strategy in VA may have prevented a substantial number of infections from MRSA and other organisms. The savings associated with the prevented infections helped to offset some but not all of the cost of the initiative. Including spillover effects of organism-specific prevention efforts onto other organisms can provide a more comprehensive evaluation of the costs and benefits of these interventions.

Impacts:
Economic evaluations of these interventions can help decision makers understand the tradeoffs between increased cost and improved health that can come from such interventions.