Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T17:55:30.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-Effectiveness Analysis of Active Surveillance Screening for Methicillin-Resistant Staphylococcus aureus in an Academic Hospital Setting

Published online by Cambridge University Press:  02 January 2015

JaHyun Kang ,
Paul Mandsager ,
Andrea K. Biddle  and
David J. Weber
JaHyun Kang*
Affiliation:
School of Nursing, University of North Carolina, Chapel Hill, North Carolina
Paul Mandsager
Affiliation:
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
Andrea K. Biddle
Affiliation:
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
*
314F Carrington Hall, Campus Box 7460, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the cost-effectiveness of 3 alternative active screening strategies for methicillin-resistant Staphylococcus aureus (MRSA): universal surveillance screening for all hospital admissions, targeted surveillance screening for intensive care unit admissions, and no surveillance screening.

Design.

Cost-effectiveness analysis using decision modeling.

Methods.

Cost-effectiveness was evaluated from the perspective of an 800-bed academic hospital with 40,000 annual admissions over the time horizon of a hospitalization. All input probabilities, costs, and outcome data were obtained through a comprehensive literature review. Effectiveness outcome was MRSA healthcare-associated infections (HAIs). One-way and probabilistic sensitivity analyses were conducted.

Results.

In the base case, targeted surveillance screening was a dominant strategy (ie, was associated with lower costs and resulted in better outcomes) for preventing MRSA HAL Universal surveillance screening was associated with an incremental cost-effectiveness ratio of $14,955 per MRSA HAL In one-way sensitivity analysis, targeted surveillance screening was a dominant strategy across most parameter ranges. Probabilistic sensitivity analysis also demonstrated that targeted surveillance screening was the most cost-effective strategy when willingness to pay to prevent a case of MRSA HAI was less than $71,300.

Conclusion.

Targeted active surveillance screening for MRSA is the most cost-effective screening strategy in an academic hospital setting. Additional studies that are based on actual hospital data are needed to validate this model. However, the model supports current recommendations to use active surveillance to detect MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 5 , May 2012 , pp. 477 - 486
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996–1011.CrossRefGoogle Scholar
2.Nelson, RE, Samore, MH, Smith, KJ, Harbarth, S, Rubin, MA. Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers. Clin Microbiol Infect 2010;16: 1740–1746.CrossRefGoogle ScholarPubMed
3.Shorr, AF. Epidemiology and economic impact of methicillin-resistant Staphylococcus aureus: review and analysis of the literature. Pharmacoeconomics 2007;25:751–768.CrossRefGoogle ScholarPubMed
4.National Nosocomial Infections Surveillance (NNIS) System. NNIS System report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31: 481–498.CrossRefGoogle Scholar
5.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(suppl):S165–S193.CrossRefGoogle ScholarPubMed
6.Jackson, M, Jarvis, WR, Scheckler, WE. HICPAC/SHEA—conflicting guidelines: what is the standard of care? Am J Infect Control 2004;32:504–511.CrossRefGoogle ScholarPubMed
7.Steinberg, EP, Luce, BR. Evidence based? caveat emptor! Health Aff (Millwood) 2005;24:80–92.CrossRefGoogle ScholarPubMed
8.Peterson, LR, Diekema, DJ. To screen or not to screen for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2010;48: 683–689.CrossRefGoogle ScholarPubMed
9.McGinigle, KL, Gourlay, ML, Buchanan, IB. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus eurews-related morbidity, mortality, and costs: a systematic review. Clin Infect Dis 2008; 46:1717–1725.CrossRefGoogle ScholarPubMed
10.Nulens, E, Broex, E, Ament, A, et al. Cost of the methicillinresistant Staphylococcus aureus search and destroy policy in a Dutch university hospital. J Hosp Infect 2008;68:301–307.CrossRefGoogle Scholar
11.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.CrossRefGoogle ScholarPubMed
12.Chang, S, Sethi, AK, Stiefel, U, Cadnum, JL, Donskey, CJ. Occurrence of skin and environmental contamination with methicillin-resistant Staphylococcus aureus before results of polymerase chain reaction at hospital admission become available. Infect Control Hosp Epidemiol 2010;31:607–612.CrossRefGoogle ScholarPubMed
13.Weber, SG, Huang, SS, Oriola, S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enter-ococci: position statement from the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2007;28:249–260.CrossRefGoogle ScholarPubMed
14.Anderson, DJ, Kaye, KS, Chen, LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLoS One 2009;4:e8305.CrossRefGoogle ScholarPubMed
15.Clancy, M, Graepler, A, Wilson, M, Douglas, I, Johnson, J, Price, CS. Active screening in high-risk units is an effective and cost-avoidant method to reduce the rate of methicillin-resistant Staphylococcus aureus infection in the hospital. Infect Control Hosp Epidemiol 2006;27:1009–1017.CrossRefGoogle ScholarPubMed
16.Murthy, A, De Angelis, G, Pittet, D, Schrenzel, J, Uckay, I, Harbarth, S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010;16:1747–1753.CrossRefGoogle ScholarPubMed
17.Lee, BY, Bailey, RR, Smith, KJ, et al. Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 2010;31:598–606.CrossRefGoogle ScholarPubMed
18.Gold, MR, Siegel, JE, Russell, LB, Weinstein, MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press, 1996.CrossRefGoogle ScholarPubMed
19.Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. New York: Oxford University Press, 2005.CrossRefGoogle Scholar
20.Briggs, A, Claxton, K, Sculpher, M. Decision Modeling for Health Economics Evaluation. New York: Oxford University Press, 2006.CrossRefGoogle Scholar
21.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.CrossRefGoogle ScholarPubMed
22.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
23.Conterno, LO, Shymanski, J, Ramotar, K, et al. Real-time polymerase chain reaction detection of methicillin-resistant Staphylococcus aureus: impact on nosocomial transmission and costs. Infect Control Hosp Epidemiol 2007;28:1134–1141.CrossRefGoogle ScholarPubMed
24.US Bureau of Labor Statistics. Consumer price index. 2010. http://www.bls.gov/cpi/. Accessed November 1, 2010.Google Scholar
25.US Bureau of Labor Statistics. May 2009 national occupational employment and wage estimates, United States. 2010. http://www.bls.gov/oes/2009/may/oes_nat.htm. Accessed November 1, 2010.Google Scholar
26.US Bureau of Labor Statistics. National compensation survey-wages. 2011. http://www.bls.gov/ncs/ocs/compub.htm#Division. Accessed November 3, 2011.Google Scholar
27.Stinnett, AA, Mullahy, J. Net health benefits: a new framework for the analysis of uncertainly in cost-effectiveness analysis. Med Decis Making 1998;18(suppl):S68–S80.CrossRefGoogle Scholar
28.Nyman, JA, Lees, CH, Bockstedt, LA, et al. Cost of screening intensive care unit patients for methicillin-resistant Staphylococcus aureus in hospitals. Am J Infect Control 2011;39:27–34.CrossRefGoogle ScholarPubMed
29.Mangini, E, Segal-Maurer, S, Burns, J, et al. Impact of contact and droplet precautions on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2007;28:1261–1266.CrossRefGoogle ScholarPubMed
30.National Nosocomial Infections Surveillance (NNIS) System. NNIS System report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522–533.CrossRefGoogle Scholar
31.Garrison, T. Intensive care. In: Association for Professionals in Infection Control and Epidemiology (APIC), eds. APIC Text of Infection Control and Epidemiology. 3rd ed. Washington, DC: APIC, 2009.Google Scholar
32.Anderson, DJ, Sexton, DJ. Whither infection control in community hospitals? musings about the near future. Infect Control Hosp Epidemiol 2008;29:1071–1073.CrossRefGoogle ScholarPubMed
33.Elixhauser, A, Steiner, C. Infections with methicillin-resistant Staphylococcus aureus (MRSA) in U.S. hospitals, 1993-2005. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb35.pdf. Accessed November 1, 2010.Google Scholar
34.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.CrossRefGoogle ScholarPubMed
35.Leonhardt, KK, Yakusheva, O, Phelan, D, et al. Clinical effectiveness and cost benefit of universal versus targeted methicillin-resistant Staphylococcus aureus screening upon admission in hospitals. Infect Control Hosp Epidemiol 2011;32:797–803.CrossRefGoogle ScholarPubMed
36.Marshall, C, Harrington, G, Wolfe, R, Fairley, CK, Wesselingh, S, Spelman, D. Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit. Infect Control Hosp Epidemiol 2003;24:322–326.CrossRefGoogle Scholar
37.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330–338.CrossRefGoogle ScholarPubMed
38.Kilgore, ML, Ghosh, K, Beavers, CM, Wong, DY, Hymel, PA Jr, Brossette, SE. The costs of nosocomial infections. Med Care 2008; 46:101–104.CrossRefGoogle ScholarPubMed
39.Puzniak, LA, Gillespie, KN, Leet, T, Kollef, M, Mundy, LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418–424.CrossRefGoogle ScholarPubMed
40.Agency for Healthcare Research and Quality. HCUP facts and figures: statistics on hospital-based care in the United States, 2008. http://www.hcup-us.ahrq.gov/reports/factsandfigures/2008/pdfs/FF_report_2008.pdf. Accessed November 1, 2010.Google Scholar