Cost-Benefit Analysis of Universal Screening and Contact Precautions for Methicillin-resistant Staphylococcus aureus Carriers from the Hospital Perspective
Background: There are data suggesting potential benefit to screening hospitalized patients for MRSA colonization followed by institution of contact precautions for carriers. However, MRSA screening, like most prevention interventions, has associated costs that must be put into context of potential benefits. Given recent legislative mandates for MRSA surveillance, we sought to explore the economic impact to a hospital of universal MRSA screening for all inpatient admissions.
Methods: We modeled the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions for MRSA carriers. Projected costs and benefits were based on literature derived data. Our model examined outcomes of several screening strategies including the addition of non-nares MRSA screening and comparison of chromatogenic agar versus PCR based screening.
Results: In our base model, the cost of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA related infections, resulting in a cost of $103,000 per 10,000 admissions ([95% credibility range, $83,000 to $126,000]). Non-nares screening and PCR-based testing, both of which identified more MRSA colonized persons, resulted in more MRSA infections averted, but increased costs of the screening program. Our results were robust for most of the model's assumptions. Cost-savings associated with MRSA screening only occurred when the model was forced to simultaneously use estimates at the extremes of our sensitivity analyses for multiple key model assumptions.
Conclusion: We found that universal MRSA screening, while providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome from an individual hospital perspective. Policy makers should consider the economic burdens of MRSA screening and contact precautions in relation to other interventions when choosing to invest in programs to improve patient safety and outcomes.
J. A. Mckinnell,
B. Lee, None
S. S. Huang, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product
L. Miller, None