Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

Gijs Hubben,Diarmuid Glynn,Marc Bonten,Maarten Postma,David Bishai,Michiel Luteijn,Martin Bootsma,Pieter H M Van Baal

doi:10.1371/journal.pone.0014783

Abstract

BackgroundScreening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.Methodology/Principal FindingsA simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively.Conclusions/SignificanceAdmission screening costs $4,100–$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.

Highlights

Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections
We present the average cost effectiveness ratios for each strategy, calculated as the costs of screening and isolation costs divided by the difference in methicillin-resistant Staphylococcus aureus (MRSA) infections, relative to a baseline of no screening and no isolation
Based upon our simulation model, three important conclusions can be drawn related to MRSA admission screening: (1) Excluding any financial benefits from averted infections, the choice of strategy depends on the setting, the costs of isolation and the hospital’s willingness to pay to avert infection

Summary

Introduction

Staphylococcus aureus is one of the most common causes of nosocomial and community-acquired infections. Since the 1980s, methicillinresistant S. aureus (MRSA) nosocomial prevalence levels have increased in most countries [1,2,3]. The low nosocomial prevalence in Scandinavian countries and the Netherlands has been ascribed to stringent policies to control the spread of MRSA. Bootsma et al have investigated the contribution of different components of the Dutch Search and Destroy policy [7], indicating that admission screening can effectively reduce MRSA in high prevalence settings [8]. Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings

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Conclusion