An Economic Evaluation Estimating the Clinical and Economic Burden of Increased Vancomycin-Resistant Enterococcus faecium Infection Incidence in Japan

Motoyuki Sugai; Akira Yuasa; Ryan L Miller; Vasileios Vasilopoulos; Hitomi Kurosu; Amer Taie; Jason P Gordon; Tetsuya Matsumoto

doi:10.1007/s40121-023-00826-w

An Economic Evaluation Estimating the Clinical and Economic Burden of Increased Vancomycin-Resistant Enterococcus faecium Infection Incidence in Japan

Infect Dis Ther. 2023 Jun;12(6):1695-1713. doi: 10.1007/s40121-023-00826-w. Epub 2023 Jun 11.

Authors

Motoyuki Sugai¹, Akira Yuasa², Ryan L Miller³, Vasileios Vasilopoulos³, Hitomi Kurosu¹, Amer Taie⁴, Jason P Gordon³, Tetsuya Matsumoto⁵

Affiliations

¹ Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan.
² Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-Ku, Tokyo, 151-8589, Japan. akira.yuasa@pfizer.com.
³ Health Economics and Outcomes Research Ltd., Cardiff, UK.
⁴ Pfizer R&D UK Limited, Tadworth, UK.
⁵ Department of Infectious Diseases, School of Medicine, International University of Health and Welfare, Narita, Japan.

Abstract

Introduction: While incidence rates of vancomycin-resistant Enterococcus faecium have remained comparatively low in Japan, there have been increasing reports of more vancomycin-resistant Enterococcus (VRE) outbreaks, requiring costly measures to contain. Increased incidence of VRE in Japan may lead to more frequent and harder to contain outbreaks with current control measures, causing a significant burden to the healthcare system in Japan. This study aimed to demonstrate the clinical and economic burden of vancomycin-resistant E. faecium infections to the Japanese healthcare system and the impact of increasing rates of vancomycin resistance.

Methods: A de novo deterministic analytic model was developed to assess the health economic outcomes of treating hospital-acquired VRE infections; patients are treated according to a two-line treatment strategy, dependent on their resistance status. The model considers hospitalisation costs and the additional cost of infection control. Scenarios investigated the current burden of VRE infections and the additional burden of increased incidence of VRE. Outcomes were assessed over a 1-year and 10-year time horizon from a healthcare payer's perspective in a Japanese setting. Quality-adjusted life years (QALYs) were valued with a willingness-to-pay threshold of ¥5,000,000 ($38,023), and costs and benefits were discounted at a rate of 2%.

Results: Current VRE incidence levels in enterococcal infections in Japan equates to ¥130,209,933,636 ($996,204,669) in associated costs and a loss of 185,361 life years (LYs) and 165,934 QALYs over 10 years. A three-fold increase (1.83%) is associated with an additional ¥4,745,059,504 ($36,084,651) in total costs on top of the current cost burden as well as an additional loss of 683 LYs over a lifetime, corresponding to 616 QALYs lost.

Conclusion: Despite low incidence rates, VRE infections already represent a substantial economic burden to the Japanese healthcare system. The substantial increase in costs associated with a higher incidence of VRE infections could result in a significant economic challenge for Japan.

Keywords: Economic evaluation; Enterococcus faecalis; Hospital-acquired infections; Japan; Vancomycin-resistant Enterococcus.