Cost-effectiveness of screening, decolonisation and isolation strategies for carbapenem-resistant Enterobacterales and methicillin-resistant Staphylococcus aureus infections in hospitals: a sex-stratified mathematical modelling study

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dc.article.number044050
dc.catalogadorcarga
dc.contributor.authorAllel, Kasim
dc.contributor.authorGarcia, Patricia
dc.contributor.authorPeters, Anne
dc.contributor.authorMunita, Jose
dc.contributor.authorUndurraga, Eduardo A.
dc.contributor.authorYakob, Laith
dc.date.accessioned2025-08-30T11:00:50Z
dc.date.available2025-08-30T11:00:50Z
dc.date.issued2025
dc.description.abstractBackground Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacterales (CRE) impose the greatest burden among critical bacterial pathogens. Evidence for sex differences among antibiotic resistant bacterial infections is increasing but a focus on policy implications is needed. We assessed impact of CRE/MRSA on excess length of hospital stay, intensive care unit admission, and mortality by sex from a retrospective cohort study (n = 873) of patients in three Chilean hospitals, 2018-2021. Methods We used inverse-probability weighting combined with descriptive, logistic, and competing-risks analyses. We developed a sex-stratified deterministic compartmental model to analyse hospital transmission dynamics and the cost-effectiveness of nine interventions. We compared interventions based on the incremental costeffectiveness ratio (ICER) per quality-adjusted life year (QALY) gained and estimated net benefits. Findings The adjusted odds of women acquiring CRE and MRSA were 0.44 (0.28-0.70; p = 0.0013) and 0.73 (95% CI = 0.48-1.01; p = 0.050), respectively. Competing-risk models indicated higher mortality rates among women, compared to men. Mathematical model projections showed that pre-emptive isolation across all newly admitted high-risk men was the most cost-effective intervention (ICER = $1366/QALY and $1083/QALY for CRE and MRSA, respectively). Chromogenic agar coupled with MRSA decolonisation was the second most cost-effective intervention ($2099/QALY), followed by screening plus isolation or pre-emptive isolation strategies (ICER ranged between $2411/QALY and $4216/QALY across CRE and MRSA models). Probabilistic sensitivity analysis showed that strategies were ICER < willingness-to-pay in 80% of simulations, except for testing plus digestive decolonisation for CRE. At a 20% national hospital coverage at least $12.2 million could be saved. Interpretation Our model suggests that targeted infection control strategies would effectively address rising CRE and MRSA infections. Maximising health-economic gains may be achieved by focusing on control measures for men as primary drivers for transmission, thereby reducing the disproportionate disease burden borne by women. Copyright (c) 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
dc.description.funderAgencia Nacional de Investigacion y Desarrollo ANID, Chile
dc.format.extent2 páginas
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.lana.2025.101019
dc.identifier.eissn2784-8450
dc.identifier.issn2667-193X
dc.identifier.scopusidSCOPUS_ID:86000613596
dc.identifier.urihttps://doi.org/10.1016/j.lana.2025.101019
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/105412
dc.identifier.wosidWOS:001428857900001
dc.information.autorucNo Informado; Undurraga Fourcade, Eduardo Andres; S/I; 12868
dc.issue.numero1
dc.language.isoen
dc.nota.accesoContenido parcial
dc.pagina.final63
dc.pagina.inicio55
dc.publisherBloomsbury Publishing Plc.
dc.relation.ispartof21st Annual Conference of the International-Society-for-Environmental-Epidemiology, AUG 25-29, 2009, Dublin, IRELAND
dc.revistaLANCET REGIONAL HEALTH-AMERICAS
dc.rightsregistro bibliográfico
dc.subjectMathematical modelling
dc.subjectAntibiotic resistance
dc.subjectTransmission dynamics
dc.subjectInterventions
dc.subjectCost-effectiveness
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleCost-effectiveness of screening, decolonisation and isolation strategies for carbapenem-resistant Enterobacterales and methicillin-resistant Staphylococcus aureus infections in hospitals: a sex-stratified mathematical modelling study
dc.typeartículo
dc.volumen43
sipa.codpersvinculados12868
sipa.indexWOS
sipa.trazabilidadWOS-SCOPUS;2025-08-30
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