title: Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment.
abstract: The costs of a hospital-wide selective screening programme were analysed for a period of 19 months. During this time, 539 inpatients were screened, of whom 111 were MRSA-positive. Based on microbiological costs (staff and materials) and the costs of preventive contact isolation for 2 days until microbiological results were available (including material costs for medical consumable goods and the costs of additional nursing time), a total of 26,241.51 Euro was spent for the 539 patients screened. Based on cost units, the costs were 39.96 Euro for a patient found to be MRSA-negative and 82.33 Euro for a patient found to be MRSA-positive. Under the prospective diagnosis related groups (DRG) payment system in Germany, the costs of a prolonged hospital stay resulting from a hospital-acquired MRSA infection (HA-MRSA-I) are not reimbursed adequately by revenues, with a calculated average cost-revenue loss/patient with HA-MRSA-I of 5705.75 Euro. The screening programme was able to prevent 48% of predicted HA-MRSA-Is (35.2 patients with infection), thereby saving a predicted 200,782.73 Euro. After subtracting the screening costs, there was a net saving of 110,236.56 Euro annually. A sensitivity analysis of the break-even points for different screening frequencies and different MRSA incidence rates indicated that the screening programme became cost-effective at a low MRSA incidence rate, meaning that it can be recommended for most hospitals with an MRSA problem.
authors.affiliation: Vivantes Klinikum im Friedrichshain, Berlin, Germany. martin.wernitz@vivantes.de
authors.forename: M H
authors.initials: MH
authors.lastname: Wernitz
authors.forename: S
authors.initials: S
authors.lastname: Keck
authors.forename: S
authors.initials: S
authors.lastname: Swidsinski
authors.forename: S
authors.initials: S
authors.lastname: Schulz
authors.forename: S K
authors.initials: SK
authors.lastname: Veit
mesh_terms: D002353:Carrier State / Q000191:economics* / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology; D003953:Diagnosis-Related Groups / Q000191:economics; D004469:Economics, Hospital; D005858:Germany / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000191:economics; D008403:Mass Screening / Q000191:economics*; D016106:Methicillin Resistance / Q000235:genetics; D013203:Staphylococcal Infections / Q000191:economics* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*