title: Screening cardiac surgery patients for MRSA: an economic computer model.
abstract: OBJECTIVE
  To estimate the economic value of preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization for cardiac surgery patients.
  
  
  METHODS
  Monte Carlo decision-analytic computer simulation model.
  
  
  METHODS
  We developed a computer simulation model representing the decision of whether to perform preoperative MRSA screening and decolonizing those patients with a positive MRSA culture. Sensitivity analyses varied key input parameters including MRSA colonization prevalence, decolonization success rates, the number of surveillance sites, and screening/decolonization costs. Separate analyses estimated the incremental cost-effectiveness ratio (ICER) of the screening and decolonization strategy from the third-party payer and hospital perspectives.
  
  
  RESULTS
  Even when MRSA colonization prevalence and decolonization success rate were as low as 1% and 25%, respectively, the ICER of implementing routine surveillance was well under $15,000 per quality-adjusted life-year from both the third-party payer and hospital perspectives. The surveillance strategy was economically dominant (less costly and more effective than no testing) for most scenarios explored.
  
  
  CONCLUSIONS
  Our results suggest that routine preoperative MRSA screening of cardiac surgery patients could provide substantial economic value to third-party payers and hospitals over a wide range of MRSA colonization prevalence levels, decolonization success rates, and surveillance costs. Healthcare administrators, infection control specialists, and surgeons can compare their local conditions with our study's benchmarks to make decisions about whether to implement preoperative MRSA testing. Third-party payers may want to consider covering such a strategy.
authors.affiliation: Section 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
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Ann E
authors.initials: AE
authors.lastname: Wiringa
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Bailey
authors.forename: Vishal
authors.initials: V
authors.lastname: Goyal
authors.forename: G Jonathan
authors.initials: GJ
authors.lastname: Lewis
authors.forename: Becky Y K
authors.initials: BY
authors.lastname: Tsui
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Robert R
authors.initials: RR
authors.lastname: Muder
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D018803:Models, Economic; D009010:Monte Carlo Method; D019990:Perioperative Care; D013903:Thoracic Surgery