Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment

Abstract

The costs of a hospital-wide selective screening programme were analysed for a period of 19 months. During this time, 539 inpatients were screened, of whom 111 were MRSA-positive. Based on microbiological costs (staff and materials) and the costs of preventive contact isolation for 2 days until microbiological results were available (including material costs for medical consumable goods and the costs of additional nursing time), a total of 26,241.51 Euro was spent for the 539 patients screened. Based on cost units, the costs were 39.96 Euro for a patient found to be MRSA-negative and 82.33 Euro for a patient found to be MRSA-positive. Under the prospective diagnosis related groups (DRG) payment system in Germany, the costs of a prolonged hospital stay resulting from a hospital-acquired MRSA infection (HA-MRSA-I) are not reimbursed adequately by revenues, with a calculated average cost-revenue loss/patient with HA-MRSA-I of 5705.75 Euro. The screening programme was able to prevent 48% of predicted HA-MRSA-Is (35.2 patients with infection), thereby saving a predicted 200,782.73 Euro. After subtracting the screening costs, there was a net saving of 110,236.56 Euro annually. A sensitivity analysis of the break-even points for different screening frequencies and different MRSA incidence rates indicated that the screening programme became cost-effective at a low MRSA incidence rate, meaning that it can be recommended for most hospitals with an MRSA problem.

Cost-Effective Frozen Master Mix Modification of a Commercial Methicillin-Resistant Staphylococcus aureus PCR Assay

“…Conterno et al (3) questioned the cost-effectiveness of PCR-based MRSA screening in locales of low prevalence. Wernitz et al (14) caution laboratories to explore the role that diagnosis-related group reimbursement may play in the overall economics of a PCR-based screening program. Relating this issue of economy to a specific commercial MRSA PCR assay (from a technical standpoint), the BD GeneOhm MRSA assay provides lyophilized master mix in approximate 25-cm 3 volumes in individual vials and directs the user to reconstitute each vial with 225 l of kit-provided diluent.…”

Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011

“…Admission screening for MRSA carriage has been shown to be (cost-) effective in reducing both nosocomial infections and MRSA transmission on the wards, because it enables timely implementation of transmission-based precautions, isolation and decolonisation therapies [31,32]. Although, we did not assess to what extent isolation measures or decolonisation therapies were performed for the MRSA patients detected, applying a standardised panel of MRSA infection control measures in all participating hospitals was part of the network's quality goals and the implementation of these measures was controlled exemplarily by the regional public health authorities.…”

"Staphylococcus aureus e Staphylococcus aureus meticilina resistentes (MRSA) em profissionais de saúde e as interfaces com as infecções nosocomiais"

“…Esse resultado sinaliza os estafilococos como um dos melhores exemplos de microrganismos virulentos multifatoriais, capazes de desencadear infecções graves, enquanto fonte primária ou secundária. A sua localização na nasofaringe, entre os membros da equipe que atuam nas instituições de saúde, tem sido preocupação constante dos estudiosos nas últimas décadas (SANTOS, 1987;ALLEN et al, 1997;BECKER et al, 2003;BUERIS et al, 2005), porque, no cotidiano dessas instituições, nenhuma medida efetiva com vistas ao controle desse microrganismo tem sido aplicada na prática (NAKASHIMA et al, 1984;SANTOS, 1987 (WERNITZ et al, 2005b).…”