Screening cardiac surgery patients for MRSA: an economic computer model.

TitleScreening cardiac surgery patients for MRSA: an economic computer model.
Publication TypeJournal Article
Year of Publication2010
AuthorsLee BY, Wiringa AE, Bailey RR, Goyal V, G Lewis J, Tsui BYK, Smith KJ, Muder RR
JournalAm J Manag Care
Volume16
Issue7
Paginatione163-73
Date Published2010 Jul
ISSN1936-2692
KeywordsComputer Simulation, Cost-Benefit Analysis, Humans, Mass Screening, Methicillin-Resistant Staphylococcus aureus, Models, Economic, Monte Carlo Method, Perioperative Care, Thoracic Surgery
Abstract

OBJECTIVE: To estimate the economic value of preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening and decolonization for cardiac surgery patients.STUDY DESIGN: Monte Carlo decision-analytic computer simulation model.METHODS: We developed a computer simulation model representing the decision of whether to perform preoperative MRSA screening and decolonizing those patients with a positive MRSA culture. Sensitivity analyses varied key input parameters including MRSA colonization prevalence, decolonization success rates, the number of surveillance sites, and screening/decolonization costs. Separate analyses estimated the incremental cost-effectiveness ratio (ICER) of the screening and decolonization strategy from the third-party payer and hospital perspectives.RESULTS: Even when MRSA colonization prevalence and decolonization success rate were as low as 1% and 25%, respectively, the ICER of implementing routine surveillance was well under $15,000 per quality-adjusted life-year from both the third-party payer and hospital perspectives. The surveillance strategy was economically dominant (less costly and more effective than no testing) for most scenarios explored.CONCLUSIONS: Our results suggest that routine preoperative MRSA screening of cardiac surgery patients could provide substantial economic value to third-party payers and hospitals over a wide range of MRSA colonization prevalence levels, decolonization success rates, and surveillance costs. Healthcare administrators, infection control specialists, and surgeons can compare their local conditions with our study's benchmarks to make decisions about whether to implement preoperative MRSA testing. Third-party payers may want to consider covering such a strategy.

Alternate JournalAm J Manag Care
PubMed ID20645662
PubMed Central IDPMC3763192
Grant List1U54GM088491-0109 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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