Objective: Patients in the ICU are at the greatest risk of contracting healthcare-associated infections like methicillin-resistant Staphylococcus aureus. This study calculates the cost-effectiveness of methicillin-resistant S aureus prevention strategies and recommends specific strategies based on screening test implementation.
Design: A cost-effectiveness analysis using a Markov model from the hospital perspective was conducted to determine if the implementation costs of methicillin-resistant S aureus prevention strategies are justified by associated reductions in methicillin-resistant S aureus infections and improvements in quality-adjusted life years. Univariate and probabilistic sensitivity analyses determined the influence of input variation on the cost-effectiveness.
Setting: ICU.
Patients: Hypothetical cohort of adults admitted to the ICU.
Interventions: Three prevention strategies were evaluated, including universal decolonization, targeted decolonization, and screening and isolation. Because prevention strategies have a screening component, the screening test in the model was varied to reflect commonly used screening test categories, including conventional culture, chromogenic agar, and polymerase chain reaction.
Measurements and Main Results: Universal and targeted decolonization are less costly and more effective than screening and isolation. This is consistent for all screening tests. When compared with targeted decolonization, universal decolonization is cost-saving to cost-effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction. Results were robust to sensitivity analyses.
Conclusions: As compared with screening and isolation, the current standard practice in ICUs, targeted decolonization, and universal decolonization are less costly and more effective. This supports updating the standard practice to a decolonization approach.
1Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO.
2Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO.
3Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO.
4University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO.
*See also p. 1413.
Work was performed at University of Colorado Anschutz Medical Campus.
Dr. Curtis’ institution received funding related to influenza vaccine research in immunocompromised children from Mediummune, Sanofi-Pasteur, and Ansun BioPharma. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Address requests for reprints to: Melanie D. Whittington, PhD, 13001 E. 17th Place, Campus Box B119, Mail Stop C238, Aurora, CO 80045. E-mail: Melanie.Whittington@UCDenver.edu
