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Cost-Effectiveness of Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in an Intensive Care Unit

Published online by Cambridge University Press:  05 January 2015

Courtney A. Gidengil ,
Charlene Gay ,
Susan S. Huang ,
Richard Platt ,
Deborah Yokoe  and
Grace M. Lee
Courtney A. Gidengil*
Affiliation:
RAND Corporation, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
Charlene Gay
Affiliation:
Center for Child Health Care Studies, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Deborah Yokoe
Affiliation:
Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Grace M. Lee
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts Center for Child Health Care Studies, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts Department of Laboratory Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
*
Address correspondence to Courtney A. Gidengil, MD, MPH, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116 (gidengil@rand.org).
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Abstract

OBJECTIVE

To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection.

DESIGN

Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection.

PATIENTS AND SETTING

Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit.

METHODS

We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted.

RESULTS

A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy.

CONCLUSIONS

Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.

Infect Control Hosp Epidemiol 2015;36(1): 17–27

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 17 - 27
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: 48th Annual Meeting of the Infectious Diseases Society of America; Vancouver, British Columbia; October 21–24, 2010; abstract 426

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