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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 (jhkang@email.unc.edu)
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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

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