Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective

J. A. Otter*, P. Burgess, F. Davies, S. Mookerjee, J. Singleton, M. Gilchrist, D. Parsons, E. T. Brannigan, J. Robotham, A. H. Holmes

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

78 Citations (Scopus)


Objective To perform an economic evaluation on the cost associated with an outbreak of carbapenemase-producing Enterobacteriaceae (CPE). Methods We performed an observational economic evaluation of an outbreak of CPE (NDM-producing Klebsiella pneumoniae) affecting 40 patients in a group of five hospitals across three sites in West London. Costs were split into actual expenditure (including anti-infective costs, enhanced CPE screening, contact precautions, temporary ward-based monitors of hand and environmental practice, and environmental decontamination), and ‘opportunity cost’ (staff time, bed closures and elective surgical missed revenue). Costs are estimated from the hospital perspective over the 10-month duration of the outbreak. Results The outbreak cost €1.1m over 10 months (range €0.9–1.4m), comprising €312 000 actual expenditure, and €822 000 (range €631 000–€1.1m) in opportunity cost. An additional €153 000 was spent on Estates renovations prompted by the outbreak. Actual expenditure comprised: €54 000 on anti-infectives for 18 patients treated, €94 000 on laboratory costs for screening, €73 000 on contact precautions for 1831 contact precautions patient-days, €42 000 for hydrogen peroxide vapour decontamination of 24 single rooms, €43 000 on 2592 hours of ward-based monitors, and €6000 of expenditure related to ward and bay closures. Opportunity costs comprised: €244 000 related to 1206 lost bed-days (range 366–2562 bed-days, €77 000–€512 000), €349 000 in missed revenue from 72 elective surgical procedures, and €228 000 in staff time (range €205 000–€251 000). Reduced capacity to perform elective surgical procedures related to bed closures (€349 000) represented the greatest cost. Conclusions The cost estimates that we present suggest that CPE outbreaks are highly costly.

Original languageEnglish
Pages (from-to)188-196
Number of pages9
JournalClinical Microbiology and Infection
Issue number3
Publication statusPublished - 1 Mar 2017

Bibliographical note

Funding Information:
The research was partially funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. The researchers are independent from the funders. We acknowledge the support of the Imperial College Healthcare Trust NIHR Biomedical Research Centre (BRC).

Publisher Copyright:
© 2016 European Society of Clinical Microbiology and Infectious Diseases


  • Carbapenem
  • Carbapenem-resistant Enterobacteriaceae
  • Carbapenemase-producing Enterobacteriaceae
  • Cost
  • Economic evaluation
  • Klebsiella pneumoniae
  • New Delhi metallo-β-lactamase
  • Outbreak


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