Cost-effectiveness of universal MRSA screening on admission to surgery

Abstract

Policy-makers have recommended universal screening to reduce nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Risk profiling of MRSA carriers and rapid PCR tests are now available, yet cost-effectiveness data are limited. The present study assessed the cost-effectiveness of universal PCR screening on admission to surgery. A decision analysis model from the hospital perspective compared costs and the probability of any MRSA infection across three strategies: (i) PCR screening; (ii) screening for risk factors (prior hospitalization or antibiotic use) combined with pre-emptive isolation and contact precautions pending chromogenic agar results; and (iii) no screening. Clinical data were taken from studies at a Swiss teaching hospital as well as from published literature. Costs were derived from hospital accounting systems. Compared to no screening, the PCR strategy resulted in higher costs (CHF 10503 vs. 10358) but a lower infection probability (0.0041 vs. 0.0088), producing a base-case incremental cost-effectiveness ratio of CHF 30784 per MRSA infection avoided. The risk factor strategy was more costly yet less effective than PCR, although, after varying epidemiologic inputs, the costs and effects of both screening strategies were similar. Sensitivity analyses suggested that on-admission prevalence of MRSA carriage predicts cost-effectiveness, alongside the probability of cross-transmission, and the costs of MRSA infection, screening and contact precautions. Although reducing the risk of MRSA infection, universal PCR screening is not strongly cost-effective at our centre. However, local epidemiology plays a critical role. Settings with a higher prevalence of MRSA colonization may find universal screening cost-effective and, in some cases, cost-saving.

Update on screening and clinical diagnosis of meticillin-resistant Staphylococcus aureus (MRSA)

“…In a mathematical model of the economic benefits of universal screening and decolonisation prior to vascular surgery, universal screening and decolonisation was effective at a prevalence of ≥1% and a decolonisation success rate of ≥50% [20]. Murthy et al [21] compared the costs and probability of occurrence of MRSA infection using (i) PCR screening, (ii) screening for risk factors and pre-emptive isolation and contact precautions pending chromogenic agar results and (iii) no screening in a decision analysis model. Compared with no screening, PCR screening and screening for risk factors plus pre-emptive isolation were associated with higher costs [Swiss Francs (CHF) 10 502 and 10 511 vs. CHF 10 359, respectively] but a lower infection probability (0.009 vs. 0.004 and 0.006).…”

Decolonization in Prevention of Health Care-Associated Infections

“…A series of economic computer models found that screening and nasal decolonization are cost-effective in some patient populations but not others. Murthy et al (156) evaluated a bundled intervention that included PCR screening for MRSA prior to surgery, decolonization of patients positive for MRSA with mupirocin and CHG, and contact isolation for MRSA-positive patients. They found that this was not strongly cost-effective, meaning that the costs avoided through reducing MRSA infections did not offset the costs of screening.…”

Routine Screening for Methicillin-Resistant Staphylococcus aureus

“…The prevalence of the MRSA carrier state is approximately 5%-10%. Approximately 80%-95% of MRSA carriers are asymptomatic, yet can transmit the bacterium [5]. Three percent of patients who are colonized with MRSA will develop an MRSA infection while hospitalized, whereas only 0.1% of patients who are not colonized will develop such an infection [6].…”