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Estimating the economic cost of carbapenem-resistant Enterobacterales healthcare-associated infections in Singapore acute-care hospitals

This study, published in PLOS Global Public Health, compares the cost of carbapenem-resistant Enterobacterales (CRE) hospital-associated infections (HAI) by infection types and the annual costs of CRE HAI from the health service perspective. It describes the cost of CRE HAIs in Singapore hospitals and identifies infections with the highest costs.

Quantifying the costs of HAIs caused by CRE can aid hospital decision-makers in infection prevention and control decisions.

Tree diagrams were used to estimate the costs of different CRE HAI types from the health service perspective and were compared to the costs of carbapenem-susceptible HAIs. Two approaches were used to esimate costs-direct costs of consumables for infection prevention and treatment, and costs associated with lost bed days. The cost of a HAI was extrapolated to annual CRE HAI incidence in Singapore acute-care hospitals to estimate the annual cost to the hospitals.

The study found that the cost of a CRE HAI based on direct cost and lost bed days are SGD9,913 (95% CI, SGD9,431-10,395) and SGD10,044 (95% CI, SGD9.789-10,300) respectively. CRE HAIs are markedly higher than the carbapenem-susceptible HAIs for all infection types. In both approaches, CRE pneumonia was the costliest infection. Based on a CFE HAI incidence of 233 per 100,000 inpatient admissions, CRE HAIs costed SGD12.16 mil (95% CI, SGD$11.84 mil-12.64 mil) annually based on direct costs, and SGD12.33 mil (95% CI, SGD12.01 mil-12.64 mil) annually based on lost bed days.

These findings may be useful in informing future economic evaluations of competing CRE HAI prevention and treatment programmes.

Read the full study at

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