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The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Ann E. Wiringa ,
Rachel R. Bailey ,
Vishal Goyal ,
Becky Tsui ,
G. Jonathan Lewis ,
Robert R. Muder  and
Lee M. Harrison
Bruce Y. Lee*
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Ann E. Wiringa
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Vishal Goyal
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Becky Tsui
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
University of Pittsburgh, and the Division of Infectious Diseases, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
Lee M. Harrison
Affiliation:
Infectious Disease Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
*
Public Health Computational and Operations Research (PHICOR) Group, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213 (byll@pitt.edu)
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Extract

Background and Objective.

Patients undergoing orthopedic surgery are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. We sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients.

Methods.

A stochastic decision-analytic computer simulation model was used to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payer and hospital perspectives. Sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success.

Results.

Preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payer perspective even when MRSA prevalence was as low as 1%, decolonization success was as low as 25%, and decolonization costs were as high as $300 per patient. In most scenarios this strategy was economically dominant (ie, less costly and more effective than no screening). From the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios explored.

Conclusions.

Routine preoperative screening and decolonization of orthopedic surgery patients may under many circumstances save hospitals and third-party payers money while providing health benefits.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1130 - 1138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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