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Universal Methicillin-Resistant Staphylococcus aureus (MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Rachel R. Bailey ,
Kenneth J. Smith ,
Robert R. Muder ,
Elsa S. Strotmeyer ,
G. Jonathan Lewis ,
Paul J. Ufberg ,
Yeohan Song  and
Lee H. Harrison
Bruce Y. Lee*
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Kenneth J. Smith
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Division of Infectious Diseases, Pittsburgh, Pennsylvania
Elsa S. Strotmeyer
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Paul J. Ufberg
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Yeohan Song
Affiliation:
Section of Decision Sciences and Clinical Systems Modeling, Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
Veterans Affairs Pittsburgh Health Care System, and Infectious Diseases Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
*
University of Pittsburgh, 200 Meyran Ave, Rm 217, Pittsburgh, PA 15213, ([email protected])
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Extract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.

Methods.

We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party-payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.

Results.

The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.

Conclusions.

Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 598 - 606
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Beretta, AL, Trabasso, P, Stucchi, RB, Moretti, ML. Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a university hospital from 1991 to 2001. Braz J Med Biol Res 2004;37(9:1345–1351.Google Scholar
2.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119(3):275.e15-275.e23.Google Scholar
3.Farr, BM. What to think if the results of the National Institutes of Health randomized trial of methicillin-resistant Staphylococcus aureus and van-comycin-resistant Enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir. Infect Control Hosp Epidemiol 2006;27(10:1096–1106.Google Scholar
4.Wernitz, MH, Swidsinski, S, Weist, K, et al.Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections. Clin Microbiol Infect 2005;11(6):457–465.CrossRefGoogle ScholarPubMed
5.Hsu, CC, Lin, YE, Chen, YS, Liu, YC, Muder, RR. Validation study of artificial neural network models for prediction of methicillin-resistant Staphylococcus aureus carriage. Infect Control Hosp Epidemiol 2008;29(7:607–614.Google Scholar
6.Spiegelhalter, DJ, Abrams, KR. Bayesian Approaches to Clinical Trials and Healthcare Evaluation. 1st ed. Hoboken, NJ: Wiley, 2004.Google Scholar
7.Chin, R, Lee, BY. Principles and Practice of Clinical Trial Medicine. 1st ed. New York: Elsevier/Academic Press, 2008.Google Scholar
8.Smith, KJ, Roberts, MS. Cost-effectiveness of newer treatment strategies for influenza. Am J Med 2002;113(4:300–307.Google Scholar
9.Evans, M, Hastings, N, Peacock, B. Triangular distribution. In: Statistical Distributions. 3rd ed. New York: Wiley, 2000:187–188.Google Scholar
10.Friedman, B, Jiang, HJ, Elixhauser, A. Costly hospital readmissions and complex chronic illness. Inquiry 2008;45(4:408–421.Google Scholar
11.Hernandez, C, Jansa, M, Vidal, M, et al.The burden of chronic disorders on hospital admissions prompts the need for new modalities of care: a cross-sectional analysis in a tertiary hospital. QJM 2009;102(3):193–202.Google Scholar
12.Levit, K (Thomson Reuters), Stranges, E (Thomson Reuters), Ryan, K (Thomson Reuters), Elixhauser, A (AHRQ). HCUP Facts and Figures, 2007: Statistics on Hospital-Based Care in the United States. Rockville, MD: Agency for Healthcare Research and Quality, 2008.Google Scholar
13.Wilmoth, JR, Shkolnikov, V. Human mortality database. http://www .mortality.org. Accessed January 21, 2008.Google Scholar
14.Tengs, TO, Wallace, A. One thousand health-related quality-of-life estimates. Med Care 2000;38(6:583–637.CrossRefGoogle ScholarPubMed
15.Bounthavong, M, Hsu, DI, Okamoto, MP. Cost-effectiveness analysis of linezolid vs vancomycin in treating methicillin-resistant Staphylococcus aurews-complicated skin and soft-tissue infections using a decision analytic model. Int J Clin Pract 2009;63(3:376–386.Google Scholar
16.Thompson, SG, Nixon, RM. How sensitive are cost-effectiveness analyses to choice of parametric distributions? Med Decis Making 2005;25(4):416–423.Google Scholar
17.Nixon, RM, Thompson, SG. Parametric modelling of cost data in medical studies. Stat Med 2004;23(8:1311–1331.Google Scholar
18.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10(4:561–566.CrossRefGoogle ScholarPubMed
19.Graves, N, Halton, K, Lairson, D. Economics and preventing hospital-acquired infection: broadening the perspective. Infect Control Hosp Epidemiol 2007;28(2:178–184.CrossRefGoogle ScholarPubMed
20.Maragakis, IX, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6(5): 751–763.Google Scholar
21.Ben-David, D, Novikov, I, Mermel, LA. Are there differences in hospital cost between patients with nosocomial methicillin-resistant Staphylococcus aureus bloodstream infection and those with methicillin-susceptible S. aureus bloodstream infection? Infect Control Hosp Epidemiol 2009;30(5): 453–460.CrossRefGoogle ScholarPubMed
22.Resch, A, Wilke, M, Fink, C. The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals. Eur J Health Econ 2009;10(3:287–297.Google Scholar
23.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5): 362–386.Google Scholar
24.McGinigle, KL, Gourlay, ML, Buchanan, IB. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus-related morbidity, mortality, and costs: a systematic review. Clin Infect Dis 2008;46(11:1717–1725.Google Scholar
25.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19(3:181–185.Google Scholar
26.Schultz, ED, Tanaka, DT, Goldberg, RN, Benjamin, DK, Smith, PB. Effect of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit on total hospital cost. Infect Control Hosp Epidemiol 2009;30(4:383–385.Google Scholar
27.Goetghebeur, M, Landry, PA, Han, D, Vicente, C. Methicillin-resistant Staphylococcus aureus: a public health issue with economic consequences. Can J Infect Dis Med Microbiol 2007;18(1):27–34.Google Scholar
28.Tiemersma, EW, Bronzwaer, SL, Lyytikainen, O, et al.Methicillin-resistant Staphylococcus aureusin Europe, 1999-2002. Emerg Infect Dis 2004;10(9): 1627–1634.Google Scholar
29.Tomic, V, Svetina Sorli, P, Trinkaus, D, Sorli, J, Widmer, AF, Trampuz, A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004;164(18:2038–2043.Google Scholar
30.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299(10:1149–1157.CrossRefGoogle ScholarPubMed