Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission

• Published in: PloS one 2015-09, Vol.10 (9), p.e0138999-e0138999
• Main Authors: Chowers, Michal, Carmeli, Yehuda, Shitrit, Pnina, Elhayany, Asher, Geffen, Keren
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacteremia; Bacteremia - diagnosis; Bacteremia - economics; Bacteremia - prevention & control; Care and treatment; Control equipment; Cost analysis; Cost engineering; Cost-Benefit Analysis; Cross Infection - economics; Cross Infection - microbiology; Cross Infection - prevention & control; Development and progression; Disease control; Drug resistance; Economic aspects; Equipment costs; Health aspects; Hospital Costs; Hospitalization; Hospitals; Humans; Infection control; Infection Control - economics; Infectious diseases; Intervention; Laboratories; Mathematical analysis; Medicine; Methicillin; Methicillin-Resistant Staphylococcus aureus - drug effects; Microbial drug resistance; Microbiology; Nosocomial infection; Nosocomial infections; Patients; Prevention; Risk factors; Risk groups; Staphylococcal Infections - microbiology; Staphylococcal Infections - prevention & control; Staphylococcal Infections - transmission; Staphylococcus aureus; Staphylococcus aureus infections; Staphylococcus infections; Streptococcus infections; Surveillance
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0138999

Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia. We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel. An average of 20,000 patients were screened yearly. The cost of prevention was $208,100 per year, with the major contributor being laboratory cost. We calculated that our intervention averted 34 cases of bacteremia yearly: 17 presenting on admission and 17 acquired in the hospital. The average cost of a case admitted with bacteremia was $14,500, and the net cost attributable to nosocomial bacteremia was $9,400. Antibiotics contributed only 0.4% of the total disease management cost. When the annual cost of averted cases of bacteremia and that of prevention were compared, the intervention resulted in annual cost savings of $199,600. A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country.