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Cost-Benefit Analysis from the Hospital Perspective of Universal Active Screening Followed by Contact Precautions for Methicillin-Resistant Staphylococcus aureus Carriers

Published online by Cambridge University Press:  05 January 2015

James A. McKinnell ,
Sarah M. Bartsch ,
Bruce Y. Lee ,
Susan S. Huang  and
Loren G. Miller
James A. McKinnell*
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California Torrance Memorial Medical Center, Torrance, California
Sarah M. Bartsch
Affiliation:
Public Health Computational and Operations Research Group (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
Bruce Y. Lee
Affiliation:
Public Health Computational and Operations Research Group (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
*
Address correspondence to Yohei Doi, MD, PhD, Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, Torrance Memorial Medical Center, Torrance, California (dr.mckinnell@yahoo.com).
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Abstract

OBJECTIVE

To explore the economic impact to a hospital of universal methicillin-resistant Staphylococcus aureus (MRSA) screening.

METHODS

We used a decision tree model to estimate the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions. Projected costs and benefits were based on literature-derived data. Our model examined outcomes of several strategies including non-nares MRSA screening and comparison of culture versus polymerase chain reaction–based screening.

RESULTS

Under baseline conditions, the costs of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in economic costs of $104,000 per 10,000 admissions (95% CI, $83,000–$126,000). Cost-savings occurred only when the model used estimates at the extremes of our key parameters. Non-nares screening and polymerase chain reaction–based testing, both of which identified more MRSA-colonized persons, resulted in more MRSA infections averted but increased economic costs of the screening program.

CONCLUSIONS

We found that universal MRSA screening, although providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome for a hospital. Policy makers should consider the economic burden of MRSA screening and contact precautions in relation to other interventions when choosing programs to improve patient safety and outcomes.

Infect Control Hosp Epidemiol 2015;36(1): 2–13

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 2 - 13
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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