Browsing by Author "Loeb, Mark"

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    A Cost-Effectiveness Analysis of a Decolonization Protocol for Staphylococcus aureus Prior to Hip and Knee Arthroplasty in Alberta, Canada
    (2019-04-30) Rennert-May, Elissa; Manns, Braden J.; Conly, John M.; Smith, Stephanie Wrenn; Puloski, Shannon K. T.; Henderson, Elizabeth Ann; Loeb, Mark
    There are over 100,000 knee/hip replacements yearly in Canada. While these procedures improve mobility and quality of life, approximately 1% develop complex surgical site infections (SSIs) after surgery. Detailed costing analysis of these infections, particularly in Canada, is lacking. We assessed incidence and cost of complex SSIs following primary hip/knee arthroplasty in patients across Alberta. We then evaluated the cost-effectiveness of an evidence-based decolonization protocol in patients prior to hip/knee arthroplasty in Alberta, compared with standard care (no decolonization) using decision analysis. Among 24,667 operations, 1.04% developed a complex SSI. The most common causative pathogen was Staphylococcus aureus (38%). Mean first-year costs for the infected and non-infected cohort were CAN $95,321 (IQR49,623 – 120,636) and $19,893 (IQR12,610 – 19,723), respectively. The decolonization protocol was associated with lower risk of complex SSI and cost savings of $153/person. A decolonization protocol should be considered for implementation in Alberta to reduce infections and save costs.
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    The Cost-Effectiveness of a Prevention Strategy for Clostridioides difficile Infections in Alberta Health Services
    (2019-04-30) Leal, Jenine Rocha; Manns, Braden; Henderson, Elizabeth Ann; Conly, John M.; Ronksley, Paul Everett; Loeb, Mark; Noseworthy, Tom W.
    The clinical and economic burden of hospital-acquired Clostridioides difficile infection (HA-CDI) is significant, however there is uncertainty in the cost-effectiveness of implementing probiotics for the primary prevention of HA-CDI among hospitalized patients prescribed antibiotics. In this thesis we examined the predictors of mortality and length of stay among this patient population in Alberta. We determined the attributable cost of HA-CDI and applied these estimates in a cost-effectiveness analysis of probiotics for the primary prevention of HA-CDI in Alberta from the perspective of a publicly-funded healthcare system. We conducted three studies: a population-based, retrospective cohort study using clinical surveillance, administrative and laboratory databases to determine the predictors of 30-day all-cause and attributable mortality and length of stay; a propensity score-matched study to compare patients with HA-CDI to patients without CDI to determine the attributable cost of HA-CDI in Alberta; and a cost-effectiveness analysis using decision analytic modelling to evaluate the costs and consequences related to probiotic use for the primary prevention of CDI. We found that the incidence and mortality rates of HA-CDI are declining, though the latter was not statistically significant. Advancing age was associated with all outcomes after adjusting for a number of baseline factors. Increased baseline white blood cell counts were associated with a lower risk of mortality. Hospital-acquired CDI total adjusted costs were 27% higher and length of stay was 13% higher than non-cases of CDI. Oral probiotics as a preventive strategy for CDI resulted in a lower risk of CDI and cost-savings. Previous studies on the burden of HA-CDI have been limited in their size and scope. Our first study was the largest population-based cohort study evaluating predictors of mortality; while our second study was the first to use propensity score-matching and a micro-costing approach for the estimation of costs associated with HA-CDI. We were the first to conduct an economic evaluation of probiotics for the primary prevention of CDI. This work will be presented to Alberta Health Services to support the evaluation of probiotics as a preventive strategy against CDI and whether to scale up probiotics to all provincial hospitals.
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    Serological Response to Influenza Vaccination among Children Vaccinated for Multiple Influenza Seasons
    (PLoS, 2012-12-11) Rafiq, Sajjad; Russell, Margaret L.; Webby, Richard; Fonseca, Kevin; Smieja, Marek; Singh, Pardeep; Loeb, Mark