title: Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.
abstract: OBJECTIVE To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. DESIGN Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. PATIENTS AND SETTING Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit. METHODS We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. RESULTS A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy. CONCLUSIONS Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.
authors: 1RAND Corporation,Boston,Massachusetts.
authors: Courtney A
authors: CA
authors: Gidengil
authors: 3Center for Child Health Care Studies,Harvard Pilgrim Health Care Institute and Harvard Medical School,Boston,Massachusetts.
authors: Charlene
authors: C
authors: Gay
authors: 4Division of Infectious Diseases and Health Policy Research Institute,University of California Irvine School of Medicine,Irvine,California.
authors: Susan S
authors: SS
authors: Huang
authors: 5Department of Population Medicine,Harvard Pilgrim Health Care Institute and Harvard Medical School,Boston,Massachusetts.
authors: Richard
authors: R
authors: Platt
authors: 6Division of Infectious Diseases,Brigham and Women's Hospital and Harvard Medical School,Boston,Massachusetts.
authors: Deborah
authors: D
authors: Yokoe
authors: 2Division of Infectious Diseases,Boston Children's Hospital and Harvard Medical School,Boston,Massachusetts.
authors: Grace M
authors: GM
authors: Lee
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use; D002353:Carrier State / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D006291:Health Policy; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods; D007362:Intensive Care Units / Q000191:economics*; D008390:Markov Chains; D055624:Methicillin-Resistant Staphylococcus aureus; D018803:Models, Economic; D011159:Population Surveillance; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
references: PLoS One. 2011;6(9):e24340
references: 21949707
references: BMJ. 2011;343:d5694
references: 21980062
references: Crit Care. 2006;10(3):R97
references: 16808853
references: Clin Infect Dis. 2006 Oct 15;43(8):971-8
references: 16983607
references: Infect Control Hosp Epidemiol. 2006 Oct;27(10):1009-17
references: 17006806
references: Infect Control Hosp Epidemiol. 2006 Oct;27(10):1032-40
references: 17006809
references: J Infect Dis. 2007 Feb 1;195(3):330-8
references: 17205470
references: Antimicrob Agents Chemother. 2007 Feb;51(2):423-8
references: 17116664
references: Infect Control Hosp Epidemiol. 2007 Mar;28(3):341-5
references: 17326027
references: Infect Control Hosp Epidemiol. 2007 Mar;28(3):358-61
references: 17326031
references: Infect Control Hosp Epidemiol. 2007 Oct;28(10):1155-61
references: 17828692
references: Infect Control Hosp Epidemiol. 2007 Sep;28(9):1036-43
references: 17932823
references: JAMA. 2007 Oct 17;298(15):1763-71
references: 17940231
references: Emerg Infect Dis. 2007 Dec;13(12):1840-6
references: 18258033
references: Ann Intern Med. 2008 Mar 18;148(6):409-18
references: 18347349
references: Infect Control Hosp Epidemiol. 2008 Jun;29(6):503-9
references: 18510459
references: Clin Infect Dis. 2008 Jul 15;47(2):176-81
references: 18532892
references: N Engl J Med. 2008 Aug 21;359(8):821-32
references: 18716299
references: Infect Control Hosp Epidemiol. 2008 Nov;29(11):996-1011
references: 18947320
references: J Am Geriatr Soc. 2009 Jan;57(1):46-54
references: 19054183
references: Am J Clin Pathol. 2009 Apr;131(4):532-9
references: 19289589
references: Infect Control Hosp Epidemiol. 2009 May;30(5):453-60
references: 19344266
references: Crit Care Med. 2009 Jun;37(6):1858-65
references: 19384220
references: Infect Control Hosp Epidemiol. 2009 Jul;30(7):623-32
references: 19496730
references: Infect Control Hosp Epidemiol. 2009 Oct;30(10):959-63
references: 19712033
references: Infect Control Hosp Epidemiol. 2010 Aug;31(8):779-83
references: 20594110
references: Clin Infect Dis. 2010 Sep 15;51 Suppl 2:S198-208
references: 20731577
references: Infect Control Hosp Epidemiol. 2011 Jan;32(1):1-8
references: 21133794
references: N Engl J Med. 2011 Apr 14;364(15):1407-18
references: 21488763
references: N Engl J Med. 2011 Apr 14;364(15):1419-30
references: 21488764
references: JAMA. 1999 Nov 10;282(18):1745-51
references: 10568647
references: Infect Control Hosp Epidemiol. 2001 Feb;22(2):99-104
references: 11232886
references: Infect Control Hosp Epidemiol. 2002 Feb;23(2):106-8
references: 11893146
references: Infect Control Hosp Epidemiol. 2002 Aug;23(8):429-35
references: 12186207
references: Am J Infect Control. 2002 Nov;30(7):430-3
references: 12410221
references: Clin Infect Dis. 2003 Jan 1;36(1):53-9
references: 12491202
references: Clin Infect Dis. 2003 Feb 1;36(3):281-5
references: 12539068
references: Clin Infect Dis. 2003 Mar 1;36(5):592-8
references: 12594640
references: Infect Control Hosp Epidemiol. 2006 Mar;27(3):271-8
references: 16532415
references: J Natl Cancer Inst. 2006 Jun 7;98(11):774-82
references: 16757702
references: Chest. 2011 Nov;140(5):1232-42
references: 21868469
references: JAMA. 2012 Feb 22;307(8):804-12
references: 22357831
references: Infect Control Hosp Epidemiol. 2013 Feb;34(2):151-60
references: 23295561
references: J Am Med Inform Assoc. 2013 Jun;20(e1):e139-46
references: 23571848
references: N Engl J Med. 2013 Jun 13;368(24):2255-65
references: 23718152
references: JAMA Intern Med. 2013 Nov 25;173(21):1970-8
references: 24043270
references: Am J Infect Control. 2003 Apr;31(2):97-103
references: 12665743
references: Infect Control Hosp Epidemiol. 2003 Jun;24(6):415-21
references: 12828317
references: Infect Control Hosp Epidemiol. 2004 May;25(5):425-30
references: 15188850
references: Ann Pharmacother. 2004 Sep;38(9):1377-82
references: 15266044
references: Infect Control Hosp Epidemiol. 1991 May;12(5):303-7
references: 1865101
references: Ann Intern Med. 1992 Feb 1;116(3):267
references: 1728212
references: Am J Infect Control. 1992 Feb;20(1):11-5
references: 1554142
references: Am J Epidemiol. 1996 Mar 1;143(5):496-504
references: 8610665
references: Eur J Surg. 1998 Jun;164(6):411-8
references: 9696441
references: Infect Control Hosp Epidemiol. 1999 Jun;20(6):408-11
references: 10395142
references: Am J Infect Control. 2004 Dec;32(8):470-85
references: 15573054
references: Infect Control Hosp Epidemiol. 2005 Feb;26(2):166-74
references: 15756888
references: Infect Control Hosp Epidemiol. 2005 Feb;26(2):175-83
references: 15756889
references: Crit Care Med. 2005 Jun;33(6):1266-71
references: 15942342
references: Diagn Microbiol Infect Dis. 2005 Jun;52(2):113-22
references: 15964499
references: Crit Care. 2005 Jun;9(3):R246-50
references: 15987397
references: J Clin Microbiol. 2005 Nov;43(11):5536-40
references: 16272482
references: Clin Infect Dis. 2006 Feb 1;42(3):370-6
references: 16392083