title: Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus.
abstract: BACKGROUND
  Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings.
  
  
  RESULTS
  A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively.
  
  
  CONCLUSIONS
  Admission screening costs $4,100-$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving.
authors.affiliation: Department of Pharmacy, University of Groningen, Groningen, The Netherlands. g.hubben@basecase.com
authors.forename: Gijs
authors.initials: G
authors.lastname: Hubben
authors.forename: Martin
authors.initials: M
authors.lastname: Bootsma
authors.forename: Michiel
authors.initials: M
authors.lastname: Luteijn
authors.forename: Diarmuid
authors.initials: D
authors.lastname: Glynn
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Marc
authors.initials: M
authors.lastname: Bonten
authors.forename: Maarten
authors.initials: M
authors.lastname: Postma
mesh_terms: D006801:Humans; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity*; D010343:Patient Admission; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology