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Cost-effectiveness analysis of a whole genome sequencing test compared to the standard care among patients with hospital-acquired bacteremia

Ding, Zhijie (2017) Cost-effectiveness analysis of a whole genome sequencing test compared to the standard care among patients with hospital-acquired bacteremia. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria have becoming increasingly prevalent in the US in the past decade. Klebsiella pneumoniae presents significant clinical challenges, as they are frequently misclassified and highly resistant to all commonly available antimicrobials, leading to delay in treatment and rapid spread in the hospital. With its high sensitivity and significantly reduced price, whole genome sequencing (WGS) has been considered a viable approach to help facilitate the identification of KPC-positive K. pneumonia from patient isolates from gastrointestinal endoscopy. However, evidence for its cost-effectiveness is lacking, which is of high public health significance.
Objective: to compare the cost-effectiveness of WGS and the standard of care (SOC, high-level disinfection), in the detection and prevention of KPC-positive K. pneumonia.
Methods: A hypothetical cohort of 1000 patients was simulated for ten years using a four-state Markov model. KPC-positive K. pneumoniae-caused infection-related healthcare costs and quality-adjusted life year (QALY) were estimated for both the WGS strategy and the SOC strategy.
Results: The base case analysis showed that with the infection rate assumed to be 1% and the cost of WGS at $100 per test, the ten-year mean cost for a patient in the WGS strategy was $3,281.80 with 8.0819 QALYs gained, while the total cost for the SOC strategy was $4,583.50 with 8.0507 QALYs gained. Under these conditions, the SOC strategy was dominated by the WGS strategy. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) revealed that WGS remained economically dominant compared to SOC with the willingness-to-pay level at $50,000.
Conclusion: In summary, the WGS strategy is more cost effective in identifying PC-positive K. pneumonia than SOC strategy.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Ding, Zhijiezhd3@pitt.eduZHD3
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorJalal,
Committee MemberRoberts,
Committee MemberRoy,
Date: 25 September 2017
Date Type: Publication
Defense Date: 19 June 2017
Approval Date: 25 September 2017
Submission Date: 20 July 2017
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 35
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Cost-Effectiveness, Whole Genome Sequencing, Klebsiella Pneumoniae, Bacteremia, Hospital-Acquired Infection
Date Deposited: 25 Sep 2017 14:20
Last Modified: 01 Jul 2020 05:15


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