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Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial

Published online by Cambridge University Press:  10 May 2016

Susan S. Huang ,
Edward Septimus ,
Taliser R. Avery ,
Grace M. Lee ,
Jason Hickok ,
Robert A. Weinstein ,
Julia Moody ,
Mary K. Hayden ,
Jonathan B. Perlin  and
Richard Platt
...Show all authors
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Orange, California
Edward Septimus
Affiliation:
Hospital Corporation of America and Texas A&M Health Science Center College of Medicine, Houston, Texas
Taliser R. Avery
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Jason Hickok
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Robert A. Weinstein
Affiliation:
Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
Julia Moody
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Mary K. Hayden
Affiliation:
Department of Pathology and Laboratory Medicine, Rush University Medical Center, Chicago, Illinois
Jonathan B. Perlin
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
G. Thomas Ray
Affiliation:
Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, California
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Objective.

To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).

Design.

Cost analysis using decision modeling.

Methods.

We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.

Results.

In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.

Conclusions.

A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S23 - S31
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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