Should Universal Surveillance for Methicillin-resistant Staphylococcus aureus (MRSA) Be Performed in Neonatal Units?

Background: Newborns may be particularly susceptible to Methicillin-resistant Staphylococcus aureus (MRSA) colonization, infections, and severe complications because of their underdeveloped immune systems. Performing universal MRSA surveillance of inpatient newborns and placing colonized neonates on contact precautions is one potential method of preventing transmission.  However, the economic value of this strategy has yet to be clearly established. 

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.