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INTRODUCTION: Carbapenemase-producing Enterobacterales (CPE) are bacteria that produce carbapenemases, enzymes that destroy carbapenem antibiotics and result in carbapenem resistance. Early identification of individuals who have been colonised or infected is important to correctly implement infection prevention and control procedures. Chromogenic media culture is traditionally the most common method of screening for high-risk patients. However, there is a long wait for results, which has substantial cost and operational implications. Xpert Carba-R is a rapid molecular test that provides CPE screening results in 50 min. This study aimed to assess the cost impact of high-risk CPE screening with Xpert Carba-R compared with media culture.
METHODS: An economic model was developed using a probabilistic cost-comparison approach to estimate the costs associated with Xpert Carba-R, from a National Health Service and personal social services perspective. The model cohort was individuals at high risk of CPE colonisation and used an 8.30-day mean time horizon for all patients to cover hospitalisation time, with an extra 5.80 days added for patients that were truly colonised to cover the time they would spend in isolation (14.10-day time horizon overall). Deterministic sensitivity analysis and scenario analysis were used to determine the robustness of the findings.
RESULTS: The model found that Xpert Carba-R is cost saving compared with media culture, with incremental cost savings of £818.28 per person. Despite greater technology costs, there are cost savings associated with preventing unnecessary isolation.
CONCLUSION: The analysis found Xpert Carba-R to be cost saving compared with media culture for CPE screening in high-risk patients. The model did not explore onwards transmission or the opportunity cost of releasing isolation spaces, so the cost savings are likely to be far greater than those demonstrated in this study.
BACKGROUND: Healthcare accounts for up to 5% of worldwide carbon emissions and costs global economies an estimated $9 trillion annually. Primary care accounts for up to one-fifth of all NHS carbon emissions, with musculoskeletal (MSK) pain accounting for 14%-30% of all primary care consultations.
METHODS: A cost-carbon calculator model was used to undertake a retrospective economic and environmental analysis of resource use for non-inflammatory MSK pain primary care consulters. Data used to populate the model was derived from Electronic Health Records and patient surveys collected during The Multi-level Integrated Data for Musculoskeletal Health Intelligence and ActionS GP Study. The model was utilised to estimate the mean (with 95%CI's) cost and carbon output per MSK consulter, while also examining variations at two levels: (a) the Primary Care Network (PCN), and (b) the consulter's index MSK pain site.
RESULTS: One thousand eight hundred seventy-five individuals from 30 NHS primary care practices across 13 PCNs were eligible for EHR and survey data analysis. The mean carbon and cost output per person (over 6 months) was 46.91 kg CO2e (95% CIs; 45.02, 48.81 kg CO2e) and £182.65 (95% CIs; £178.69, £190.62), respectively, with substantial variation observed across PCNs. The resource category with the highest carbon footprint was consistently pharmacological intervention across all PCNs. Individuals who consulted for multisite/widespread pain and back pain had the highest mean carbon and cost output respectively.
CONCLUSION: This is the first study, we are aware of, that presents data on both the environmental and economic impact of the primary care of non-inflammatory MSK pain. Future work should focus on benchmarking the cost and carbon output of MSK care pathways and standardising methods that are implemented to influence sustainable practice and policy development.
AIM: The study was to characterize participant responses in a time trade-off (TTO) task involving states worse than dead (WTD) to determine patterns of congruence and incongruence.
METHODS: The online TTO task involved 4 hypothetical health states describing a rare paediatric condition. Participants completed the task from a parental perspective with a 10-year time horizon. Mean health utilities were derived for the health states (HS). Congruence patterns were defined a priori as "perfect", i.e. completely logical sequence of health state utilities, "incongruent", reversal of the most and least severe HS utilities, and "mixed" congruence. A multinomial regression and latent class analysis (LCA) were applied to elucidate congruence patterns.
RESULTS: A total of 322 participants completed the TTO (49% females; average age 43 years). Perfect congruence response patterns were observed in only 11.5% (37) participants; 99 participants (30.8%) had incongruent response patterns and 186 (57.8%) a mixture. Two (most severe) HS were rated WTD by the "mixed", but only one HS was rated WTD by the "perfect" congruence group, who rated the other 3 HS better than dead. The multinomial regression identified age and gender as potential factors influencing congruence patterns; the most impactful factor was the number of stated rated WTD. The LCA was not able to identify a single class of perfectly congruent responders.
LIMITATIONS: This online TTO did not allow further exploration of individual choices through post-task participant interviews.
CONCLUSIONS: Facets of TTO tasks such as states WTD may introduce an additional cognitive burden on participants and impact on congruence. However, incongruence was observed even within ostensibly perfectly congruent responses; conversely incongruent response patterns showed some internal coherence. Removing the latter in favour of the former may therefore also introduce bias. A balance may need to be struck between sacrificing perfect congruence and the inclusion of some incongruence to achieve greater representativeness of health state utilities.
LAY SUMMARY: Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract disease (LRTD) and accounts for significant morbidity and mortality, particularly in older adults. This modelling study evaluated the public health benefits and cost-effectiveness of mRNA-1345, an RSV vaccine, in preventing RSV-related outcomes in people aged =60 years in the UK. The analysis found that mRNA-1345 vaccination reduced RSV-related case numbers, hospitalisations and deaths. mRNA-1345 is cost-effective for preventing RSV-related disease in older adults.
INTRODUCTION: RSV is an important cause of LRTD in older adults. In September 2024, NHS England will introduce its first RSV vaccination campaign, which includes adults aged 75-80 years and those turning 75 years. Countries such as Australia, Canada, the US and France recommend an RSV vaccine for subgroups of people =60 years. This modelling study explored the cost-effectiveness and public health impact of a novel RSV vaccine (mRNA-1345) using clinical trial data for UK adults aged =60 and =65 years.
METHODS: The cost-effectiveness model was built from a UK NHS perspective and used a decision-analytic structure over three years. Based on phase 2/3 clinical trial data (18.8-months median follow-up), mRNA-1345 was presumed to prevent RSV-acute respiratory disease (ARD),RSV-LRTD, and RSV-LRTD hospitalisations amongst those developing infections. To address the known issue of under detection of RSV, the sourced RSV hospitalisation rates were adjusted using a published multiplier of 1.5. Calibration techniques were performed to ensure external validation. Costs, quality-adjusted life-years (QALYs) and population-related parameters were sourced from publicly available sources.
RESULTS: Vaccination of adults =60 years with a single dose of mRNA-1345 results in a 23.8% and 35.1% reduction in RSV-ARD and RSV-LRTD cases over three years, compared with no vaccine, respectively. For a population of 16,814,195 adults =60 years, without RSV vaccination, the annual number of RSV hospitalisations is projected to be 36,696. The annual number of hospitalisations aligns with published literature when adjusted for the under detection of RSV. A single dose of mRNA-1345 is estimated to save 40,558 (38.9%) hospitalisations over three years. The NNV to prevent one RSV-LRTD case, hospitalisation and death is 44, 293 and 527, respectively. There are 39.8% less RSV-related deaths and, consequently, 161,947 life years are gained over three years. Incurred costs from mRNA-1345 implementation are offset by 123,824 QALYs gained to produce an ICER of £14,557 per QALY gained.
The direction of the results for adults =65 years remained consistent. The ICER fell to £12,425 per QALY gained. mRNA-1345 vaccination was estimated to save 38,581 (40.1%) RSV-LRTD hospitalisations over a three-year time horizon in a population of 12,736,451 adults. It was associated with a 25.9% and 37.7% reduction in RSV-ARD and RSV-LRTD cases, respectively.
CONCLUSION: Vaccination with mRNA-1345 could have a substantial impact on reducing RSV-related morbidity and mortality in UK adults aged =60 years. The vaccine could contribute to reducing ongoing winter pressures for the NHS. The ICER for mRNA-1345 is substantially lower than the UK willingness-to-pay threshold of £20,000 per QALY gained, suggesting that RSV vaccination with mRNA-1345 is highly cost effective.
BACKGROUND: Community-acquired pneumonia (CAP) remains a leading cause of hospital admissions and mortality. A novel host-response test, MeMed BV (MMBV), has been developed for discriminating between bacterial and viral infection that could improve the clinical management of CAP.
OBJECTIVES: To evaluate the cost-effectiveness of using MMBV to guide antibiotic decisions in the clinical management of CAP in the UK.
METHODS: An economic model was developed to understand the incremental cost per person associated with the implementation of MMBV from the UK NHS perspective. A qualitative care pathway analysis was performed to inform the standard of care (SOC) and SOC plus MMBV (SOC + MMBV) clinical pathways captured in the model.
RESULTS: In the base case analysis, the SOC + MMBV strategy for a hypothetical cohort of 1000 patients (adults and children modelled independently) presenting to the emergency department with suspected CAP was estimated to provide total cost savings of £134 018 and £105 750 for adults and children, respectively. Cost savings were associated with reductions in total antibiotic treatment, the number of patients receiving additional diagnostic tests, and hospital admissions. Deterministic sensitivity analysis revealed that the specificity of SOC + MMBV and sensitivity of the SOC were primary drivers of the cost model for adults, whereas the specificity of SOC and SOC + MMBV were primary drivers for paediatrics.
CONCLUSIONS: Overall, the model predicts that the introduction of SOC + MMBV has the potential to be cost-saving and promote antimicrobial stewardship for both adult and paediatric CAP patients.
