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Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

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

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.

Suggested Citation

  • Gijs Hubben & Martin Bootsma & Michiel Luteijn & Diarmuid Glynn & David Bishai & Marc Bonten & Maarten Postma, 2011. "Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus," PLOS ONE, Public Library of Science, vol. 6(3), pages 1-11, March.
  • Handle: RePEc:plo:pone00:0014783
    DOI: 10.1371/journal.pone.0014783
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    Cited by:

    1. Christopher Fuller & Julie Robotham & Joanne Savage & Susan Hopkins & Sarah R Deeny & Sheldon Stone & Barry Cookson, 2013. "The National One Week Prevalence Audit of Universal Meticillin-Resistant Staphylococcus aureus (MRSA) Admission Screening 2012," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-1, September.
    2. Sierk D. Marbus & Valentijn A. Schweitzer & Geert H. Groeneveld & Jan J. Oosterheert & Peter M. Schneeberger & Wim Hoek & Jaap T. Dissel & Arianne B. Gageldonk-Lafeber & Marie-Josée Mangen, 2020. "Incidence and costs of hospitalized adult influenza patients in The Netherlands: a retrospective observational study," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(5), pages 775-785, July.
    3. Virginia R Roth & Tara Longpre & Doug Coyle & Kathryn N Suh & Monica Taljaard & Katherine A Muldoon & Karamchand Ramotar & Alan Forster, 2016. "Cost Analysis of Universal Screening vs. Risk Factor-Based Screening for Methicillin-Resistant Staphylococcus aureus (MRSA)," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-16, July.

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