Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus

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

Research output: Contribution to journalArticle

Abstract

Background: 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. Methodology/Principal Findings: A 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/Significance: Admission 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.

Original languageEnglish (US)
Article numbere14783
JournalPLoS One
Volume6
Issue number3
DOIs
StatePublished - 2011

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Methicillin
Methicillin-Resistant Staphylococcus aureus
Screening
screening
Costs and Cost Analysis
Chromogenics
Polymerase Chain Reaction
Infection
Costs
infection
cost effectiveness
Insurance Benefits
Cross Infection
methicillin-resistant Staphylococcus aureus
Cost-Benefit Analysis
testing
Delivery of Health Care
cross infection
health services
simulation models

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus. / Hubben, Gijs; Bootsma, Martin; Luteijn, Michiel; Glynn, Diarmuid; Bishai, David M; Bonten, Marc; Postma, Maarten.

In: PLoS One, Vol. 6, No. 3, e14783, 2011.

Research output: Contribution to journalArticle

Hubben, Gijs ; Bootsma, Martin ; Luteijn, Michiel ; Glynn, Diarmuid ; Bishai, David M ; Bonten, Marc ; Postma, Maarten. / Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus. In: PLoS One. 2011 ; Vol. 6, No. 3.
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