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265 Evaluating the economic value of Methicillin-resistant Staphylococcus aureus (MRSA) testing: A Stochastic Simulation Model

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Rachel R. Bailey, MPH , University of Pittsburgh, Pittsburgh, PA
Kenneth J. Smith, MD, MS , University of Pittsburgh, Pittsburgh, PA
Paul J. Ufberg, DO, MBA , University of Pittsburgh, Pittsburgh, PA
G. Jonathan Lewis, DO, MPH , University of Pittsburgh, Pittsburgh, PA
Ronald Voorhees , University of Pittsburgh, Pittsburgh, PA
Lee H. Harrison, MD , Univ of Pittsburgh Med Ctr, Pittsburgh, PA
Alyssa Willig , University of Pittsburgh, Pittsburgh, PA
Maria M. Brooks, PhD , University of Pittsburgh, Pittsburgh, PA
Robert R. Muder, MD , VA Pittsburgh Healthcare Sys, Pittsburgh, PA
Bruce Y. Lee, MD, MBA , University of Pittsburgh, Pittsburgh, PA
Background: Widespread implementation of methicillin-resistant Staphylococcus aureus (MRSA) testing remains controversial. Testing protocols (i.e. anatomic sites to be cultured and turnaround time) and local epidemiological conditions (i.e. MRSA prevalence, net reproductive rate (R), and efficacy of contact isolation in preventing secondary cases) ultimately impact the economic value of MRSA testing.

Objective: To evaluate the impact of both testing protocols and local epidemiological conditions on the economic value of MRSA testing.

Methods: From the third party payer perspective, we developed a stochastic computer simulation model evaluating the economic value of testing adult inpatients for MRSA. Sensitivity analyses systematically varied both testing protocols and local epidemiological conditions.

Results: Local MRSA conditions and turnaround time were chief drivers of the economic value of MRSA testing. When turnaround time was two days, R is 0, and prevalence was 1%, the cost per case averted was $156,802. Decreasing turnaround time to a single day resulted in a cost per case averted of $74,439. As isolation efficacy decreased from 75% to 50% to 25%, the cost per case averted increased from $11,110 to $20,406 to $43,725.

Conclusions: The economic value of MRSA testing was highly impacted by the efficacy of contact isolation protocols and test turnaround time. Testing multiple anatomic sites had little added economic value. Efforts ought to be made to decrease test turnaround time and improve adherence to isolation protocols.