title: Cost Analysis of Universal Screening vs. Risk Factor-Based Screening for Methicillin-Resistant Staphylococcus aureus (MRSA).
abstract: BACKGROUND
  The literature remains conflicted regarding the most effective way to screen for MRSA. This study was designed to assess costs associated with universal versus risk factor-based screening for the reduction of nosocomial MRSA transmission.
  
  
  METHODS
  The study was conducted at The Ottawa Hospital, a large multi-centre tertiary care facility with approximately 47,000 admissions annually. From January 2006-December 2007, patients underwent risk factor-based screening for MRSA on admission. From January 2008 to August 2009 universal MRSA screening was implemented. A comparison of costs incurred during risk factor-based screening and universal screening was conducted. The model incorporated probabilities relating to the likelihood of being tested and the results of polymerase chain reaction (PCR) testing with associated effects in terms of MRSA bacteremia and true positive and negative test results. Inputted costs included laboratory testing, contact precautions and infection control, private room costs, housekeeping, and length of hospital stay. Deterministic sensitivity analyses were conducted.
  
  
  RESULTS
  The risk factor-based MRSA screening program screened approximately 30% of admitted patients and cost the hospital over $780 000 annually. The universal screening program screened approximately 83% of admitted patients and cost over $1.94 million dollars, representing an excess cost of $1.16 million per year. The estimated additional cost per patient screened was $17.76.
  
  
  CONCLUSIONS
  This analysis demonstrated that a universal MRSA screening program was costly from a hospital perspective and was previously known to not be clinically effective at reducing MRSA transmission. These results may be useful to inform future model-based economic analyses of MRSA interventions.
authors.affiliation: Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Roth
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Longpre
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Health Economics Research Group, Brunel University, Uxbridge, Middlesex, United Kingdom.
authors.forename: Doug
authors.initials: D
authors.lastname: Coyle
authors.affiliation: Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Suh
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Katherine A
authors.identifier: http://orcid.org/0000-0002-0766-4294
authors.initials: KA
authors.lastname: Muldoon
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Karamchand
authors.initials: K
authors.lastname: Ramotar
authors.affiliation: Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Forster
mesh_terms: D002170:Canada; D017721:Hospital Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D025202:Molecular Diagnostic Techniques / Q000191:economics* / Q000379:methods; D015397:Program Evaluation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000191:economics*