Cost-effectiveness of strategies to prevent MRSA transmission and infection in an intensive care unit
Published Date:Jan 2015
Source:Infect Control Hosp Epidemiol. 36(1):17-27.
Corporate Authors:for the CDC Prevention Epicenters Program
Anti-Infective Agents, Local
Intensive Care Units
Methicillin-Resistant Staphylococcus Aureus
Pubmed Central ID:PMC4311265
Funding:U01 CI000344/CI/NCPDCID CDC HHS/United States
U54 GM088558/GM/NIGMS NIH HHS/United States
U54GM088558/GM/NIGMS NIH HHS/United States
We created a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent MRSA transmission and infection.
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.
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.
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.
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.
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