University of Groningen Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus

Background: Screening at hospital admission for carriage of methicillin-resistant Staphylococcus aureus (MRSA) has been proposed as a strategy to reduce nosocomial infections. The objective of this study was to determine the long-term costs and health benefits of selective and universal screening for MRSA at hospital admission, using both PCR-based and chromogenic media-based tests in various settings. Methodology/Principal Findings: A simulation model of MRSA transmission was used to determine costs and effects over 15 years from a US healthcare perspective. We compared admission screening together with isolation of identified carriers against a baseline policy without screening or isolation. Strategies included selective screening of high risk patients or universal admission screening, with PCR-based or chromogenic media-based tests, in medium (5%) or high nosocomial prevalence (15%) settings. The costs of screening and isolation per averted MRSA infection were lowest using selective chromogenic-based screening in high and medium prevalence settings, at $4,100 and $10,300, respectively. Replacing the chromogenic-based test with a PCR-based test costs $13,000 and $36,200 per additional infection averted, and subsequent extension to universal screening with PCR would cost $131,000 and $232,700 per additional infection averted, in high and medium prevalence settings respectively. Assuming $17,645 benefit per infection averted, the most cost-saving strategies in high and medium prevalence settings were selective screening with PCR and selective screening with chromogenic, respectively. Conclusions/Significance: Admission screening costs $4,100–$21,200 per infection averted, depending on strategy and setting. Including financial benefits from averted infections, screening could well be cost saving. Citation: Hubben G, Bootsma M, Luteijn M, Glynn D, Bishai D, et al. (2011) Modelling the Costs and Effects of Selective and Universal Hospital Admission Screening for Methicillin-Resistant Staphylococcus aureus. PLoS ONE 6(3): e14783. doi:10.1371/journal.pone. 0014783 Editor: Pieter H. M. van Baal, Erasmus University Rotterdam, The Netherlands Received April 27, 2010; Accepted November 17, 2010; Published March 31, 2011 Copyright: 2011 Hubben et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This study was financially supported by Becton Dickinson (San Diego, CA; www.bd.com) and 3M (Minneapolis, MI; www.3m.com) through research grants without publication restrictions. The funders had no role in study design, data collection and analysis, data interpretation, decision to publish, or preparation of the manuscript. MCJB and MJMB are supported by the Netherlands Organization for Scientific Research (VENI NWO GRANT 916-05-041 and VICI NWO Grant 918.76.611 www.nwo.nl). GAAH, DMG, DB, MJP, and JML have no financial disclosures. Competing Interests: This study was financially supported by Becton Dickinson (San Diego, CA) and 3M (Minneapolis, MI), through research grants without publication restrictions. This did not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. GAAH and DMG are financially supported by BaseCase (Berlin, Germany). In their capacities as consultants for BaseCase software, GAAH and DMG have performed consulting work for Becton Dickinson. This did not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. DB, MJP, and JML declare no competing interests. * E-mail: g.hubben@basecase.com . These authors contributed equally to this work.