Economic Impact of Pre-Operative Screening and Decolonization of Orthopedic Surgery Patients for Methicillin-resistant Staphylococcus aureus (MRSA)

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections in orthopedic surgery patients have been associated with prolonged hospital stays, higher mean number of surgical procedures, and a lower rate of satisfactory outcomes. Patients undergoing orthopedic surgery are at particular risk for MRSA infections post-operatively. Screening all patients for MRSA pre-operatively and decolonizing those who test positive is a potential strategy to reduce the risk of MRSA infections in this patient population. Examination of the cost-effectiveness of such a strategy is important to determine before applying it universally.

Objective: Determine the potential economic impact of pre-operative MRSA screening and decolonization for patients undergoing orthopedic surgery.
Methods: A decision analytic computer simulation model was developed to evaluate the potential economic value of implementing universal MRSA testing pre-operatively in all orthopedic surgery patients. Sensitivity analyses evaluated the impact of MRSA prevalence, decolonization success, and decolonization cost on the economic value of such a strategy.

Results: When the cost of decolonization is set at $200/patient, performing MRSA surveillance and decolonization is a less costly and more effective strategy than no testing when MRSA prevalence ≥ 0.025 and decolonization success rate ≥ 0.75; MRSA prevalence ≥ 0.05 and decolonization success rate ≥ 0.5; and MRSA prevalence ≥ 0.1 and decolonization success rate ≥ 0.25. The strategy remained cost-effective when MRSA prevalence ≥ 0.01 and decolonization success ≥ 0.25.

Conclusions: Universal MRSA testing and pre-operative decolonization in all orthopedic surgery patients may be a cost-effective strategy over a wide range of MRSA prevalence, decolonization success rates, and decolonization costs.