1387. Using an Agent-Based Simulation Model to Conduct an Economic Analysis of Strategies to Control Clostridium difficile Transmission and infection
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 2013 09-27 IDWeek C diff simulation CEA.pdf (779.6 kB)
  • Background:

    Several strategies exist to reduce Clostridium difficile (C. diff) transmission and infection. We conducted an economic evaluation of “bundling” these strategies using an agent-based simulation model.


    We constructed an agent-based computer simulation of C. diff transmission and infection in a hospital setting. This model included interactions among patients and health care workers that could result in transmission of contagion between them and the environment. Six interventions were introduced singly, then "bundled": (a) aggressive C. diff testing; (b) empiric isolation and treatment of symptomatic patients; as well as improved (c) adherence to hand hygiene (HH) and (d) contact precautions, (e) use of soap and water for HH, and (f) environmental cleaning. Our analysis compared these interventions using values representing 3 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 and effectiveness was measured as CDIs prevented. We performed sensitivity analysis varying C. diff importation prevalence and transmissibility.


    In the case of low importation prevalence (2%), INT and OPT interventions resulted in an incremental cost-effectiveness ratio of $9,726 and $33,162 per CDI prevented, respectively, compared to BASE. For both normal (7.5%) and high importation prevalence (15%) and transmissibility, INT and OPT strategies were more effective and less expensive than the BASE. In addition, OPT was both more effective and less costly compared to INT in the high importation and transmissibility scenario. When added sequentially, HH compliance and empiric isolation and treatment had the greatest impact on both cost and effectiveness.   


    Using a dynamic cost-effectiveness analysis, we find that bundled interventions to prevent CDI are likely to reduce costs and CDI under conditions of normal to high C. diff importation prevalence and transmissibility.

    Richard E. Nelson, PhD1, Makoto Jones, MD, MS2, Molly Leecaster, PhD3, William Ray4, Angela Huttner, MD5, Benedikt Huttner, MD6, Karim Khader, PhD7, Jose Campo, MD6, Dale Gerding, MD, FIDSA8, Matthew Samore, MD9 and Michael Rubin, MD, PhD10, (1)Internal Medicine, University of Utah, Salt Lake City, UT, (2)Internal Medicine, University of Utah School of Medicine Division of Epidemiology, Salt Lake City, UT, (3)Salt Lake City VA Health Care System, Salt Lake City, UT, (4)University of Utah, Salt Lake City, UT, (5)VA Salt Lake City Health Care System and University of Utah, Salt Lake City, Utah, USA, Salt Lake City, UT, (6)IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (7)VA Salt Lake City Healthcare System, Salt Lake City, UT, (8)Hines VA Hospital, Hines, IL, (9)University of Utah School of Medicine, Salt Lake City, UT, (10)Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT


    R. E. Nelson, None

    M. Jones, None

    M. Leecaster, None

    W. Ray, None

    A. Huttner, None

    B. Huttner, None

    K. Khader, None

    J. Campo, None

    D. Gerding, ViroPharma: Consultant and Patents licensed, Consulting fee and Patent license continuation fee
    Merck: Scientific Advisor, Consulting fee
    Actelion: Scientific Advisor, Consulting fee
    Sanofi Pasteur: Scientific Advisor, Consulting fee
    Cangene: Consultant, Consulting fee
    Roche: Consultant, Consulting fee
    Novartis: Consultant, Consulting fee
    Cubist: Consultant, Consulting fee
    Rebiotix: Consultant, Consulting fee
    GOJO: Grant Investigator, Research grant
    Cepheid: Grant Investigator, Research grant

    M. Samore, None

    M. Rubin, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.