Related Experiment Video
Updated: Sep 17, 2025
Author Spotlight: Advancing Rapid Detection of Respiratory Pathogens Using Microfluidic Chip
Published on: March 29, 2024
An exploratory cost-effectiveness analysis of methicillin-resistant Staphylococcus aureus nares PCR in pediatric
Evan E Facer1, Zachary Aldewereld1,2, Michael D Green1
1Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Objective:
To estimate the cost-effectiveness of methicillin-resistant Staphylococcus aureus (MRSA) nares poymerase chain reaction (PCR) use in pediatric pneumonia and tracheitis.
Methods:
We built a cost-effectiveness model based on MRSA prevalence and probability of empiric treatment for MRSA pneumonia or tracheitis, with all parameters varied in sensitivity analyses. The hypothetical patient cohort was <18 years of age and hospitalized in the pediatric intensive care unit for community-acquired pneumonia (CAP) or tracheitis. Two strategies were compared: MRSA nares PCR-guided antibiotic therapy versus usual care. The primary measure was cost per incorrect treatment course avoided. Length of stay and hospital costs unrelated to antibiotic costs were assumed to be the same regardless of PCR use. Both literature data and expert estimates informed sensitivity analysis ranges.
Results:
When estimating the health care system willingness-to-pay threshold for PCR testing as $140 (varied in sensitivity analyses) per incorrect treatment course avoided, reflecting estimated additional costs of MRSA targeted antibiotics, and MRSA nares PCR true cost as $64, PCR testing was generally favored if empiric MRSA treatment likelihood was >52%. PCR was not favored in some scenarios when simultaneously varying MRSA infection prevalence and likelihood of MRSA empiric treatment. Screening becomes less favorable as MRSA PCR cost increased to the highest range value of the parameter ($88). Individual variation of MRSA colonization rates over wide ranges (0% - 30%) had lesser effects on results.
Conclusions:
MRSA nares PCR use in hospitalized pediatric patients with CAP or tracheitis was generally favored when empiric MRSA empiric treatment rates are moderate or high.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) nares PCR testing is cost-effective for pediatric pneumonia and tracheitis when empiric MRSA treatment is likely. This approach helps avoid incorrect antibiotic courses in hospitalized children.
Area of Science:
- Infectious Diseases
- Pediatric Critical Care
- Health Economics
Background:
- Hospital-acquired infections, particularly methicillin-resistant Staphylococcus aureus (MRSA), pose significant challenges in pediatric care.
- Pneumonia and tracheitis are common serious infections in children requiring intensive care.
- Accurate and timely diagnosis is crucial to guide appropriate antibiotic therapy and improve patient outcomes.
Purpose of the Study:
- To evaluate the cost-effectiveness of using methicillin-resistant Staphylococcus aureus (MRSA) nares polymerase chain reaction (PCR) testing in pediatric patients diagnosed with pneumonia or tracheitis.
- To determine the conditions under which MRSA nares PCR testing becomes a favorable strategy compared to standard care in a pediatric intensive care unit (PICU) setting.
Main Methods:
- A cost-effectiveness model was developed analyzing a hypothetical cohort of pediatric patients (<18 years) in the PICU with community-acquired pneumonia or tracheitis.
- The model compared two strategies: MRSA nares PCR-guided antibiotic therapy versus usual care, focusing on the cost per incorrect treatment course avoided.
- Sensitivity analyses were performed, varying parameters such as MRSA prevalence, probability of empiric MRSA treatment, and the cost of MRSA nares PCR testing.
Main Results:
- MRSA nares PCR testing was generally favored when the likelihood of empiric MRSA treatment was greater than 52%, considering a willingness-to-pay threshold of $140 per incorrect treatment course avoided.
- The cost-effectiveness of PCR testing decreased as its cost increased, with less favorable outcomes when the PCR cost reached $88.
- Variations in MRSA colonization rates within a wide range (0%-30%) had a minimal impact on the overall results.
Conclusions:
- The use of MRSA nares PCR testing in hospitalized pediatric patients with community-acquired pneumonia or tracheitis is generally cost-effective.
- This strategy is particularly beneficial in scenarios with moderate to high rates of empiric MRSA treatment.
- Optimizing diagnostic strategies like MRSA nares PCR can lead to more targeted and cost-effective antibiotic use in pediatric critical care.
