Economic Analysis of Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections.
In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission through universal screening and isolation, the Department of Veterans Affairs (VA) launched the National MRSA Prevention Initiative in October 2007. The objective of this analysis was to quantify the budget impact and cost effectiveness of this initiative.



An economic model was developed using published data on MRSA hospital-acquired infection (HAI) rates in the VA from October 2007 to September 2010; estimates of the costs of MRSA HAIs in the VA; and estimates of the intervention costs, including salaries of staff members hired to support the initiative at each VA facility. To estimate the rate of MRSA HAIs that would have occurred if the initiative had not been implemented, two different assumptions were made: no change and a downward temporal trend. Effectiveness was measured in life-years gained.



The initiative resulted in an estimated 1,466-2,176 fewer MRSA HAIs. The initiative itself was estimated to cost $207 million during this 3-year period, while the cost savings from prevented MRSA HAIs ranged from $27 million to $75 million. The incremental cost-effectiveness ratios ranged from $28,048 to $56,944/life-years. The overall impact on the VA's budget was $131-$179 million.



Wide-scale implementation of a national MRSA surveillance and prevention strategy in VA inpatient settings may have prevented a substantial number of MRSA HAIs. Although the savings associated with prevented infections helped offset some but not all of the cost of the initiative, this model indicated that the initiative would be considered cost effective.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. Electronic address: richard.nelson@utah.edu.
Richard E
RE
Nelson
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah.
Vanessa W
VW
Stevens
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Karim
K
Khader
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Makoto
M
Jones
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Matthew H
MH
Samore
Veterans Affairs Medical Center, Lexington, Kentucky; MRSA/MDRO Program, National Infectious Disease Service, Veterans Health Administration, Lexington, Kentucky; Department of Internal Medicine, University of Kentucky, Lexington, Kentucky.
Martin E
ME
Evans
Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia.
R
R
Douglas Scott
Division of Healthcare Quality Promotion, CDC, Atlanta, Georgia.
Rachel B
RB
Slayton
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Marin L
ML
Schweizer
Iowa City Veterans Affairs Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Eli L
EL
Perencevich
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Michael A
MA
Rubin
D003140:Communicable Disease Control / Q000379:methods; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D018803:Models, Economic; D013203:Staphylococcal Infections / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*