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Active Surveillance and Decolonization of Methicillin-Resistant Staphylococcus aureus on Admission to Neonatal Intensive Care Units in Hong Kong: A Cost-Effectiveness Analysis

Published online by Cambridge University Press:  02 January 2015

Joyce H. S. You ,
C. Y. Chan ,
M. Y. Wong  and
Margaret Ip
Joyce H. S. You*
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
C. Y. Chan
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
M. Y. Wong
Affiliation:
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
Margaret Ip
Affiliation:
Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
*
Center for Pharmacoeconomics Research, School of Pharmacy, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong (joyceyou@cuhk.edu.hk)
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Abstract

Objective.

To examine potential clinical outcomes and cost of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance with and without decolonization in neonatal intensive care units (NICUs) from the perspective of healthcare providers in Hong Kong.

Design.

Decision analysis modeling.

Setting.

NICU.

Patients.

Hypothetical cohort of patients admitted to an NICU.

Methods.

We designed a decision tree to simulate potential outcomes of active MRSA surveillance with and without decolonization in patients admitted to an NICU. Outcome measures included total direct medical cost per patient, MRSA infection rate, and MRSA-associated mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.

Results.

In the base-case analysis, active surveillance plus decolonization showed a lower expected MRSA infection rate (0.911% vs 1.759%), MRSA-associated mortality rate (0.223% vs 0.431%), and total cost per patient (USD 47,294 vs USD 48,031) compared with active surveillance alone. Sensitivity analyses showed that active surveillance plus decolonization cost less and had lower event rates if the incidence risk ratio of acquiring MRSA infections in carriers after decolonization was less than 0.997. In 10,000 Monte Carlo simulations, active surveillance plus decolonization was significantly less costly than active surveillance alone 99.9% of the time, and both the MRSA infection rate and the MRSA-associated mortality rate were significantly lower 99.9% of the time.

Conclusions.

Active surveillance plus decolonization for patients admitted to NICUs appears to be cost saving and effective in reducing the MRSA infection rate and the MRSA-associated mortality rate if addition of decolonization to active surveillance reduces the risk of MRSA infection.

Infect Control Hosp Epidemiol 2012;33(10):1024-1030

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 10 , October 2012 , pp. 1024 - 1030
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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