Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis

Abstract

BackgroundNosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective.MethodsA decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented.ResultsThe decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51.ConclusionThe forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.

Staphylococcus aureus Bacteremia in Hospitalized Patients and Associated Factors: A Cross-sectional Study from Mashhad, Iran

“…The difference rates reported can be attributed to the differences in the characteristics of the study populations as well as different diagnostic methods used for the assessment of MRSA. In addition, although the prevalence of MRSA reported in the above-mentioned reports are close to that of the present study, the origin of samples was unclear in these review studies (12,13,19), which is of great significance, as the origin of infection is associated with adverse health outcomes and increased economic burden of MRSA (20)(21)(22).…”

Antibiotics for Spinal Cord Stimulation Trials and Implants: A Survey Analysis of Practice Patterns

“…Decolonization entails application of mupirocin nasal ointment and chlorhexidine wash prior the procedure ( 22 ). About to 1/3 of the population are carriers of S. aureus, illustrating that nasal swabs are cost effective manner to identify a large portion of patients who are at higher risk of infection ( 22 , 40 ). Despite this, nasal screening may not detect up to 20% of patients with colonization ( 41 ).…”