Evaluating the economic and health impact of proactive genomic epidemiology in a hospital setting
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Genomic epidemiology which combines whole genome sequencing (WGS) of bacterial isolates with patient movement data, promises improved detection, prevention, and management of infection transmission, enhancing patient safety and reducing healthcare costs. However, evidence on its cost-effectiveness and clinical utility remains limited, as initial studies were restricted to selected pathogens and based on extrapolated assumptions from partial WGS data.
Methods
We conducted a 28-month observational study at Rigshospitalet, a 1 200-bed tertiary hospital in Copenhagen. The study involved collecting patient movement and WGS data for clinical isolates of 19 bacterial species, regardless of their site of isolation, or antibiotic susceptibility profile. This included sequencing of 18 940 clinical isolates from 7 760 patients.
Findings
We found that 27·1 % of culture-positive hospitalized patients harboured a pathogen genetically related to another patient’s isolate. 69 % had an epidemiological link, indicating transmission between patients, with Enterococcus faecium being the most prevalent. Notably, there were 2·2 times more transmissions of antibiotic-susceptible than resistant isolates. We estimated that prevention based on genomic epidemiology could potentially generate net savings of €1·25 million annually and avoid more than 750 disability adjusted life years (DALYs).
Interpretation
Our holistic, proactive genomic epidemiology approach reveals previously unexplored transmission landscapes. We discovered that transmission is widespread, varies significantly between species, and is not limited to resistant isolates. Our results highlight the potential for WGS-informed infection control, greater savings by including susceptible isolates, and an incremental cost-effectiveness ratio (ICER) classification by pathogen species.
Funding
Novo Nordisk Foundation, Beta.Health, Den Frie Forskningsfond
