Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus

• Published in: PloS one 2011-03, Vol.6 (3), p.e14783-e14783
• Main Authors: Hubben, Gijs, Bootsma, Martin, Luteijn, Michiel, Glynn, Diarmuid, Bishai, David, Bonten, Marc, Postma, Maarten
• Format: Article
• Language: English
• Subjects: Analysis; Computer simulation; Cost engineering; Costs; Cross infection; Disease control; Drug resistance; Economic aspects; Evidence-Based Healthcare/Health Services Research and Economics; Health aspects; Health care; Health care costs; Health care expenditures; Health insurance; Health sciences; Hospital admission and discharge; Hospital patients; Hospitalization; Humans; Infection control; Infectious Diseases/Bacterial Infections; Infectious Diseases/Epidemiology and Control of Infectious Diseases; Intensive care; Mass Screening - economics; Medical research; Medical screening; Methicillin; Methicillin-Resistant Staphylococcus aureus - pathogenicity; Microbial drug resistance; Nosocomial infection; Patient Admission; Patients; Pharmacy; Primary care; Public Health and Epidemiology/Health Policy; Public Health and Epidemiology/Health Services Research and Economics; Public Health and Epidemiology/Nosocomial and Healthcare-Associated Infections; Staphylococcal Infections - diagnosis; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus infections; Staphylococcus infections; Studies; Test procedures; Workloads
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0014783

Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings. A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively. Admission screening costs $4,100-$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.