Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus?
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.


METHODS
We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.


RESULTS
The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is > or = 0.01 and the decolonization success rate is > or = 0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence > or = 0.01 and decolonization success rate > or = 0.5, and MRSA prevalence > or = 0.025 and decolonization success rate > or = 0.25.


CONCLUSIONS
Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.
Section of Decision Sciences and Clinical Systems Modeling, Department of Biomedical Informatics, School of Medicine, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. BYL1@pitt.edu
Bruce Y
BY
Lee
Becky Y
BY
Tsui
Rachel R
RR
Bailey
Kenneth J
KJ
Smith
Robert R
RR
Muder
G Jonathan
GJ
Lewis
Lee H
LH
Harrison
D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D003658:Decision Making, Computer-Assisted; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D011300:Preoperative Care / Q000191:economics; D013203:Staphylococcal Infections / Q000517:prevention & control*; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*