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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.contributor.authorAllel, Kasim
dc.contributor.authorGarcia, Patricia
dc.contributor.authorPeters, Anne
dc.contributor.authorMunita, José
dc.contributor.authorUndurraga, Eduardo A.
dc.contributor.authorYakob, Laith
dc.date.accessioned2026-09-07T20:24:19Z
dc.date.available2026-09-07T20:24:19Z
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 cost-effectiveness 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.
dc.description.versionVersión publicada
dc.format.extent13 p.
dc.identifier.citationKasim Allel, Patricia Garcia, Anne Peters, Jose Munita, Eduardo A. Undurraga, Laith Yakob, 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, The Lancet Regional Health - Americas, Volume 43, 2025, 101019, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2025.101019.
dc.identifier.doihttps://doi.org/10.1016/j.lana.2025.101019
dc.identifier.urihttps://hdl.handle.net/11447/11078
dc.language.isoen
dc.rightsAtribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)
dc.rights.urihttp://creativecommons.org/licenses/by-nc-sa/3.0/cl/
dc.subjectMathematical modelling
dc.subjectAntibiotic resistance
dc.subjectTransmission dynamics
dc.subjectInterventions
dc.subjectCost-effectiveness
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.typeArticle
dcterms.accessRightsAcceso abierto
dcterms.sourceThe Lancet Regional Health - Americas
dspace.entity.typePublication

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