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Universal Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Rachel R. Bailey ,
Kenneth J. Smith ,
Robert R. Muder ,
Elsa S. Strotmeyer ,
G. Jonathan Lewis ,
Paul J. Ufberg ,
Yeohan Song  and
Lee H. Harrison
Bruce Y. Lee*
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Kenneth J. Smith
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Division of Infectious Diseases, Pittsburgh, Pennsylvania
Elsa S. Strotmeyer
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Paul J. Ufberg
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Yeohan Song
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
Veterans Affairs Pittsburgh Health Care System, and Infectious Diseases Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
*
University of Pittsburgh, 200 Meyran Ave, Rm 217, Pittsburgh, PA 15213, (BYL1@pitt.edu)
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Extract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.

Methods.

We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party-payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.

Results.

The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.

Conclusions.

Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 598 - 606
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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