title: Cost-effectiveness analysis of active surveillance screening for methicillin-resistant Staphylococcus aureus in an academic hospital setting.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of 3 alternative active screening strategies for methicillin-resistant Staphylococcus aureus (MRSA): universal surveillance screening for all hospital admissions, targeted surveillance screening for intensive care unit admissions, and no surveillance screening.
  
  
  METHODS
  Cost-effectiveness analysis using decision modeling.
  
  
  METHODS
  Cost-effectiveness was evaluated from the perspective of an 800-bed academic hospital with 40,000 annual admissions over the time horizon of a hospitalization. All input probabilities, costs, and outcome data were obtained through a comprehensive literature review. Effectiveness outcome was MRSA healthcare-associated infections (HAIs). One-way and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  In the base case, targeted surveillance screening was a dominant strategy (ie, was associated with lower costs and resulted in better outcomes) for preventing MRSA HAI. Universal surveillance screening was associated with an incremental cost-effectiveness ratio of $14,955 per MRSA HAI. In one-way sensitivity analysis, targeted surveillance screening was a dominant strategy across most parameter ranges. Probabilistic sensitivity analysis also demonstrated that targeted surveillance screening was the most cost-effective strategy when willingness to pay to prevent a case of MRSA HAI was less than $71,300.
  
  
  CONCLUSIONS
  Targeted active surveillance screening for MRSA is the most cost-effective screening strategy in an academic hospital setting. Additional studies that are based on actual hospital data are needed to validate this model. However, the model supports current recommendations to use active surveillance to detect MRSA.
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, North Carolina 27599, USA. jhkang@email.unc.edu
authors.forename: JaHyun
authors.initials: J
authors.lastname: Kang
authors.forename: Paul
authors.initials: P
authors.lastname: Mandsager
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Biddle
authors.forename: David J
authors.initials: DJ
authors.lastname: Weber
mesh_terms: D000046:Academic Medical Centers; D003362:Cost-Benefit Analysis; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D017146:Models, Organizational; D011159:Population Surveillance; D013203:Staphylococcal Infections / Q000175:diagnosis*