Details:

Alternative Title:
Infect Control Hosp Epidemiol
Personal Author:
Gidengil, Courtney ; Gay, Charlene ; Huang, Susan S ; Platt, Richard ; Yokoe, Deborah ; ... More +
Gidengil, Courtney ; Gay, Charlene ; Huang, Susan S ; Platt, Richard ; Yokoe, Deborah ; Lee, Grace M. Less -
Corporate Authors:
for the CDC Prevention Epicenters Program
Description:
Objective

We created a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent MRSA transmission and infection.

Design

Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection.

Patients and setting

Hypothetical cohort of 10,000 adult patients admitted to a U.S. ICU.

Methods

We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures (ASC); (2) ASC plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate (CHG) baths; (5) universal decolonization; (6) UCP + CHG baths; and (7) UCP + decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted.

Results

1,989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared to all strategies except UCP + decolonization and UCP + CHG. UCP + decolonization was more effective than universal decolonization, but would cost $2,469 per colonization averted and $9,007 per infection averted. If MRSA colonization prevalence drops from 12% to 5%, ASC plus selective decolonization becomes the least expensive strategy.

Conclusions

Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.


Subject:
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Adult Anti-Bacterial Agents Anti-Infective Agents, Local Article Carrier State Chlorhexidine Cost-Benefit Analysis Health Policy Hospital Costs Humans Infection Control Intensive Care Units Markov Chains Methicillin-Resistant Staphylococcus Aureus Models, Economic Population Surveillance Staphylococcal Infections
Source:
Infect Control Hosp Epidemiol. 36(1):17-27.
Pubmed ID:
25627757
Pubmed Central ID:
PMC4311265
Document Type:
Journal Article
Funding:
U01 CI000344/CI/NCPDCID CDC HHS/United States ; U54 GM088558/GM/NIGMS NIH HHS/United States ; U54GM088558/GM/NIGMS NIH HHS/United States
U01 CI000344/CI/NCPDCID CDC HHS/United States ; U54 GM088558/GM/NIGMS NIH HHS/United States ; U54GM088558/GM/NIGMS NIH HHS/United States Less -
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:d68331e8eedd191f16050dc604dcf592ad170ceb4d788ee09883c1649df14ca7
Download URL:
https://stacks.cdc.gov/view/cdc/42016/cdc_42016_DS1.pdf
File Type:

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