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Assessment of the Influence of Test Characteristics on the Clinical and Cost Impacts of Methicillin-Resistant Staphylococcus aureus Screening Programs in US Hospitals

Published online by Cambridge University Press:  02 January 2015

Natalia Olchanski ,
Charles Mathews ,
Lauren Fusfeld  and
William Jarvis
Natalia Olchanski
Affiliation:
Boston Healthcare Associates, Boston, Massachusetts
Charles Mathews*
Affiliation:
Boston Healthcare Associates, Boston, Massachusetts
Lauren Fusfeld
Affiliation:
Boston Healthcare Associates, Boston, Massachusetts
William Jarvis
Affiliation:
Jason and Jarvis Associates, Hilton Head Island, South Carolina
*
Boston Healthcare Associates, 75 Federal St., 9th Floor, Boston, MA 02110-1913 ([email protected])
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Abstract

Objective.

To compare the impacts of different methicillin-resistant Staphylococcus aureus (MRSA) screening test options (eg, polymerase chain reaction [PCR], rapid culture) and program characteristics on the clinical outcomes and budget of a typical US hospital.

Methods.

We developed an Excel-based decision-analytic model, using published literature to calculate and compare hospital costs and MRSA infection rates for PCR- or culture-based MRSA screening and then used multivariate sensitivity analysis to evaluate key variables. Same-day PCR testing for a representative 370-bed teaching hospital in the United States was assessed in different populations (high-risk patients, intensive care unit [ICU] patients, or all patients) and compared with other test options.

Results.

Different screening program populations (all patients, high-risk patients, ICU patients, or patients with previous MRSA colonization or infection only) represented a potential savings of $12,158-$76,624 per month over no program ($188,618). Analysis of multiple test options in high-risk population screening indicated that same-day PCR testing of high-risk patients resulted in fewer infections over 1,720 patient-days (2.9, compared with 3.5 for culture on selective media and 3.8 for culture on nonselective media) and the lowest total cost ($112,012). The costs of other testing approaches ranged from $113,742 to $123,065. Sensitivity analysis revealed that variations in transmission rate, conversion to infection, prevalence increases, and hospital size are important to determine program impact. Among test characteristics, turnaround time is highly influential.

Conclusion.

All screening options showed reductions in infection rates and cost impact improvement over no screening program. Among the options, same-day PCR testing for high-risk patients slightly edges out the others in terms of fewest infections and greatest potential cost savings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 3 , March 2011 , pp. 250 - 257
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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