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Screening cardiac surgery patients for MRSA: an economic computer model
Bruce Y Lee1, Ann E Wiringa, Rachel R Bailey
1Section of Decision Sciences and Clinical Systems Modeling, Department of Biomedical Informatics, University of Pittsburgh, 200 Meyran Ave, Ste 200, Pittsburgh, PA 15213, USA. byl1@pitt.edu
The American Journal of Managed Care
|July 22, 2010
Summary
Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization for cardiac surgery patients offers significant economic value. This strategy is cost-effective for payers and hospitals, even at low MRSA prevalence.
Area of Science:
- Health Economics
- Infectious Disease Prevention
- Surgical Outcomes
Background:
- Healthcare-associated infections, such as those caused by methicillin-resistant Staphylococcus aureus (MRSA), pose significant risks and economic burdens in surgical settings.
- Cardiac surgery patients are particularly vulnerable to MRSA infections, necessitating effective prevention strategies.
Purpose of the Study:
- To evaluate the economic value and cost-effectiveness of implementing preoperative MRSA screening and decolonization protocols for patients undergoing cardiac surgery.
- To determine the incremental cost-effectiveness ratio (ICER) of MRSA surveillance and treatment from both third-party payer and hospital perspectives.
Main Methods:
- A Monte Carlo decision-analytic computer simulation model was developed to assess the strategy.
- Key parameters such as MRSA colonization prevalence, decolonization success rates, surveillance site numbers, and associated costs were varied in sensitivity analyses.
- The ICER was calculated for different scenarios to compare the screening and decolonization strategy against no intervention.
Main Results:
- The strategy demonstrated substantial economic value, with ICERs well below $15,000 per quality-adjusted life-year, even with low MRSA prevalence (1%) and decolonization success rates (25%).
- In most simulated scenarios, the MRSA screening and decolonization approach was found to be economically dominant, meaning it was both less costly and more effective than standard care without screening.
- The findings remained robust across a wide range of input parameter variations, indicating consistent economic benefits.
Conclusions:
- Routine preoperative MRSA screening and decolonization represent a valuable economic investment for third-party payers and hospitals performing cardiac surgery.
- Healthcare administrators and clinicians can utilize these findings to inform decisions regarding the implementation of MRSA testing based on local epidemiological data and costs.
- Payers should consider coverage for preoperative MRSA screening and decolonization as a cost-effective measure to improve patient outcomes and reduce healthcare expenditures.
