[Economic aspects of the management and control of MRSA]

Methicillin resistance of Staphylococcus aureus strains (MRSA) has become a steadily growing cost factor for the German and international health system. Besides direct costs for diagnostics and therapy, indirect and intangible costs are a considerable part in the total expenses. Because of the massive increase of MRSA in medical centres as well as in the population and further worsening of forced rationalizing in the health care systems, the interest in the economic effects of this phenomenon has increased greatly during the last years. For managing MRSA and for effective cost containment, especially in hospitals, infection control measures have not only to prevent the further spread of MRSA but actively reduce the number of colonised patients. In the last years the efficiency of several infection control measures and their combination to prevent the spread of MRSA has been shown. However, these measures are linked to considerable direct costs in the first place. Nevertheless, an overall economic assessment of hygiene measures is only possible after a complete cost-benefit analysis, where costs are compared to effects achieved. Moreover, analyses that focus on effects for single institutions only are as inappropriate as purely monetary analyses or analyses that include the direct additional only. Despite of at first considerable expenditures, not only infection control measures but proactive strategies to reduce the total number of MRSA cases (accordingly of the "Search and Destroy" philosophy) are shown to be cost efficient, even in low prevalence situations, based on examples in literature. Hence, effective programmes to reduce MRSA are not only necessary from a medical and ethical focus but are also cost efficient in medium term for health care providers and the community.