Screening all hospital admissions for MRSA unlikely to be cost-effective

  • April 13, 2012

LONDON — A national mandatory policy of screening all elective and emergency hospital admissions for methicillin-resistant Staphylococcus aureus did not appear cost-effective. Further research examining sensitivity to model parameters, setting and long-term effects is currently under way, according to Julie Robotham, PhD.

“Targeted screening of high-risk specialties appears at this preliminary stage more likely to be cost-effective, reflecting the higher proportion of infections seen,” Robotham, of the Health Protection Agency in London, told Infectious Disease News.

Robotham and colleagues collected data from a national 1-week audit of MRSA admission screening in 144 National Health System hospitals. They used this data to develop an MRSA transmission model to evaluate the effectiveness and cost-effectiveness of 10 different screening and intervention strategies.

The health benefits of all strategies were similar. When compared with no screening, intensive screening strategies reduced MRSA infection rates by up to 20%, but there was a less than 5% reduction in mortality.

When looking at cost, the researchers found that screening of admissions to high-risk specialties had cost per quality-adjusted life years value beneath the usual National Health Service willingness-to-pay threshold.

References:

  • Robotham J. #LB2808. Presented at: 22nd European Congress of Clinical Microbiology and Infectious Diseases; March 31-April 3, 2012; London.

Disclosure:

  • Dr. Robotham reports no relevant financial disclosures.

Perspective
Peter Chin-Hong, MD

Peter Chin-Hong

  • Hospital-acquired MRSA accounts for a substantial burden of disease in some health care settings, complicating more than a quarter of a million of hospitalizations in the US every year. Conceptually, it makes sense that the identification, isolation and decolonization of asymptomatic carriers of MRSA in the hospitalized setting could decrease transmission and incident infection. However, there is little consensus on whether performing active surveillance cultures for MRSA on routinely hospitalized patients is effective in preventing infection, and ultimately mortality due to MRSA. Two large, well-performed interventional studies evaluating MRSA prevention strategies in the US, published within the last year, produced conflicting results. And, as Robotham and colleagues demonstrate with the UK NHS data, non-targeted MRSA screening may not result in cost efficacy. Surveillance in more high-risk and outbreak settings are likely to yield more favorable results. However, ultimately, it is not evidence, but rather consumers and special interest groups who are currently driving policy change to mandate MRSA surveillance. So far there are at least 15 states in the US who have enacted laws regarding screening and reporting of MRSA in hospitalized patients. Hopefully these kinds of mandates will be better informed in the future as ongoing studies continue to define the best population and setting in which this kind of surveillance will be cost effective.
    • Peter Chin-Hong, MD
    • Infectious Disease News Editorial Board member

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