title: Budget impact analysis of rapid screening for Staphylococcus aureus colonization among patients undergoing elective surgery in US hospitals .
abstract: OBJECTIVE
  To evaluate the economic impact of performing rapid testing for Staphylococcus aureus colonization before admission for all inpatients who are scheduled to undergo elective surgery and providing subsequent decolonization therapy for those patients found to be colonized with S. aureus.
  
  
  METHODS
  A budget impact model that used probabilistic sensitivity analysis to account for the uncertainties in the input variables was developed. Primary input variables included the marginal effect of S. aureus infection on patient outcomes among patients who underwent elective surgery, patient demographic characteristics, the prevalence of nasal carriage of S. aureus, the sensitivity and specificity of the rapid diagnostic test for S. aureus colonization, the efficacy of decolonization therapy for nasal carriage of S. aureus, and cost data. Data sources for the input variables included the 2003 Nationwide Inpatient Sample data and the published literature.
  
  
  RESULTS
  In 2003, there were an estimated 7,181,484 patients admitted to US hospitals for elective surgery. Our analysis indicated preadmission testing and subsequent decolonization therapy for patients colonized with S. aureus would have produced a mean annual cost savings to US hospitals of $231,538,400 (95% confidence interval [CI], -$300 million to $1.3 billion). The mean annual number of hospital-days that could have been eliminated was estimated at 364,919 days (95% CI, 67,893-926,983 days), and a mean of 935 in-hospital deaths (95% CI, 88-3,691) could have been avoided per year. Sensitivity analysis indicated a 64.5% probability that there would be cost savings to US hospitals as a result of preadmission testing and subsequent decolonization therapy.
  
  
  CONCLUSIONS
  The addition of preadmission testing and decolonization therapy to standard care would result in significant cost savings, even after accounting for variations in the model input values.
authors.affiliation: Northwestern University, the Feinberg School of Medicine, Chicago, Illinois 60611, USA. gnoskin@northwstern.edu
authors.forename: Gary A
authors.initials: GA
authors.lastname: Noskin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Rubin
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Schentag
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
authors.forename: Edwin C
authors.initials: EC
authors.lastname: Hedblom
authors.forename: Cassie
authors.initials: C
authors.lastname: Jacobson
authors.forename: Maartje
authors.initials: M
authors.lastname: Smulders
authors.forename: Eric
authors.initials: E
authors.lastname: Gemmen
authors.forename: Murtuza
authors.initials: M
authors.lastname: Bharmal
mesh_terms: D002017:Budgets; D002353:Carrier State / Q000382:microbiology; D003362:Cost-Benefit Analysis; D004469:Economics, Hospital; D017558:Elective Surgical Procedures / Q000191:economics; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification*