title: Assessment of the influence of test characteristics on the clinical and cost impacts of methicillin-resistant Staphylococcus aureus screening programs in US hospitals.
abstract: OBJECTIVE
  To compare the impacts of different methicillin-resistant Staphylococcus aureus (MRSA) screening test options (eg, polymerase chain reaction [PCR], rapid culture) and program characteristics on the clinical outcomes and budget of a typical US hospital.
  
  
  METHODS
  We developed an Excel-based decision-analytic model, using published literature to calculate and compare hospital costs and MRSA infection rates for PCR- or culture-based MRSA screening and then used multivariate sensitivity analysis to evaluate key variables. Same-day PCR testing for a representative 370-bed teaching hospital in the United States was assessed in different populations (high-risk patients, intensive care unit [ICU] patients, or all patients) and compared with other test options.
  
  
  RESULTS
  Different screening program populations (all patients, high-risk patients, ICU patients, or patients with previous MRSA colonization or infection only) represented a potential savings of $12,158-$76,624 per month over no program ($188,618). Analysis of multiple test options in high-risk population screening indicated that same-day PCR testing of high-risk patients resulted in fewer infections over 1,720 patient-days (2.9, compared with 3.5 for culture on selective media and 3.8 for culture on nonselective media) and the lowest total cost ($112,012). The costs of other testing approaches ranged from $113,742 to $123,065. Sensitivity analysis revealed that variations in transmission rate, conversion to infection, prevalence increases, and hospital size are important to determine program impact. Among test characteristics, turnaround time is highly influential.
  
  
  CONCLUSIONS
  All screening options showed reductions in infection rates and cost impact improvement over no screening program. Among the options, same-day PCR testing for high-risk patients slightly edges out the others in terms of fewest infections and greatest potential cost savings.
authors: Boston Healthcare Associates, Boston, MA 02110-1913, USA.
authors: Natalia
authors: N
authors: Olchanski
authors: Charles
authors: C
authors: Mathews
authors: Lauren
authors: L
authors: Fusfeld
authors: William
authors: W
authors: Jarvis
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics*; D003362:Cost-Benefit Analysis; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D018803:Models, Economic; D016133:Polymerase Chain Reaction / Q000191:economics; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States