Objective: To determine the potential economic impact of performing universal MRSA surveillance of inpatient newborns.
Methods: We developed a stochastic computer simulation model to determine the potential economic impact of performing universal MRSA surveillance for all inpatient newborns at different MRSA prevalence and reproductive rate (R0) thresholds. Newborns who tested positive for MRSA were placed on contact precautions. MRSA carriers not placed on contact precautions could transmit MRSA to R0 other neonates. Each new case then entered into a newborn MRSA clinical outcomes model accruing costs and utilities.
Results: Each simulation run involved sending 1,000 simulated newborns through the model 1,000 times (i.e., 1,000,000 trials). Performing surveillance was cost-effective [incremental cost-effectiveness ratio (ICER) < $50,000 per quality-adjusted life year (QALY)] at R0≥0.25 and prevalence ≥ 0.05. In fact, surveillance was the dominant strategy, (i.e. less costly and more clinically effective compared to no surveillance), when R0 ≥3.0 and prevalence ≥ 0.40.
Conclusions: At a wide range of MRSA prevalence and R0 values, universal MRSA surveillance of inpatient newborns appears to be cost-effective.