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Cost-effectiveness of different MRSA screening methods.
T Kunori1, B Cookson, J A Roberts
1Public Health and Policy Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT.
The Journal of Hospital Infection
|July 30, 2002
Summary
The most cost-effective methicillin-resistant Staphylococcus aureus (MRSA) screening involves direct nasal sampling and specific agar inoculation without broth incubation or further confirmation. This approach aids in developing better strategies for detecting MRSA in high-risk hospital units.
Area of Science:
- Clinical Microbiology
- Health Economics
- Infectious Disease Prevention
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings, necessitating effective screening strategies.
- Current laboratory screening approaches for MRSA vary, leading to a lack of standardization and agreement on optimal methods.
- The cost-effectiveness of different MRSA detection methods is crucial for resource allocation in hospitals.
Purpose of the Study:
- To develop and present a model for evaluating the cost-effectiveness of diverse laboratory-screening methods for MRSA detection.
- To explore how variations in test sensitivity, specificity, and time-to-result impact MRSA infection acquisition in high-risk units.
- To identify the most cost-effective MRSA screening strategy based on established performance metrics and cost data.
Main Methods:
- A critical literature review was conducted to gather data on sensitivity (X), specificity (S), and time to result (T) for various MRSA tests.
- Cost information was obtained from a hospital setting to integrate economic factors into the model.
- Tests were analyzed in four hierarchical groups, and their performance metrics (X, S, T) were used in formulae to calculate effectiveness.
Main Results:
- The model identified a specific, simplified screening approach as the most cost-effective: direct nasal sampling inoculated onto Ciprofloxacin Baird-Parker agar without broth incubation or further confirmation.
- This most cost-effective method involves a Pastorex Staph-Plus test without additional methicillin resistance confirmation.
- The study highlights the complexity in designing seemingly simple screening scenarios and acknowledges the need for further model refinement.
Conclusions:
- The direct nasal swab to Ciprofloxacin Baird-Parker agar, bypassing broth incubation and confirmation, is the most cost-effective MRSA screening strategy identified.
- The developed model can assist in the ongoing debate and development of more cost-effective MRSA screening strategies.
- Further refinement of the model is necessary, considering additional factors to improve its applicability and address existing standardization issues.