Impact of different diagnostic technologies for MRSA admission screening in hospitals - a decision tree analysis.

Claudia Hübner,Christian Wegner,Steffen Flessa,Nils-Olaf Hübner

doi:10.1186/s13756-015-0093-0

Abstract

BackgroundHospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide. Rapid and precise identification of MRSA carriage in combination with targeted hygienic management are proven to be effective but incur relevant extra costs. Therefore, health care providers have to decide which MRSA screening strategy and which diagnostic technology should be applied according to economic criteria.AimThe aim of this study was to determine which MRSA admission screening and infection control management strategy causes the lowest expected cost for a hospital. Focus was set on the Point-of-Care Testing (PoC).MethodsA decision tree analytic cost model was developed, primarily based on data from peer-reviewed literature. In addition, univariate sensitivity analyses of the different input parameters were conducted to study the robustness of the results.FindingsIn the basic analysis, risk-based PoC screening showed the highest mean cost savings with 14.98 € per admission in comparison to no screening. Rapid universal screening methods became favorable at high MRSA prevalence, while in situations with low MRSA transmission rates omission of screening may be favorable.ConclusionEarly detection of MRSA by rapid PoC or PCR technologies and consistent implementation of appropriate hygienic measures lead to high economic efficiency of MRSA management. Whether general or targeted screening is more efficient depends mainly on epidemiological and infrastructural parameters.

Highlights

Hospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide
Cultural testing in combination with or without pre-emptive isolation caused immensely higher costs per admission compared to the omission of any MRSA-screening with additional costs of 264.40 € or 449.81 € per admission, respectively (Table 3)
Three intervals depending on nosocomial MRSA transmission rate can be distinguished: Below a transmission rate of 0.04322 transmissions per day the omission of any screening method is the least costly strategy

Summary

Introduction

Hospital infections with multiresistant bacteria, e.g., Methicillin-resistant Staphylococcus aureus (MRSA), cause heavy financial burden worldwide. Rapid and precise identification of MRSA carriage in combination with targeted hygienic management are proven to be effective but incur relevant extra costs. Health care providers have to decide which MRSA screening strategy and which diagnostic technology should be applied according to economic criteria. Infections with Methicillin-resistant Staphylococcus aureus (MRSA) cause heavy financial burden on healthcare systems worldwide [1,2,3]. While the economic impact on nosocomial MRSA acquisition is controversial, it has been proven that rapid and precise identification of MRSA carriage at hospital admission reduces turn-. Health care providers have to decide which screening strategy to follow and which diagnostic technology to use in consideration of medical and economic criteria. Polymerase-Chain-Reaction (PCR), culture and Point-ofCare (PoC) methods are the diagnostic technologies available on the market [9]

Objectives

Methods

Results

Discussion

Conclusion