成人入院时普遍进行耐甲氧西林金黄色葡萄球菌（MRSA）监测：经济模型与分析。
Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis.
机构信息
Section of Decision Sciences and Clinical Systems Modeling, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania, USA.
出版信息
Infect Control Hosp Epidemiol. 2010 Jun;31(6):598-606. doi: 10.1086/652524.
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.
METHODS
We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party-payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.
RESULTS
The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.
CONCLUSIONS
Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.
背景
耐甲氧西林金黄色葡萄球菌（MRSA）的传播和感染是医院持续存在的问题。尽管有人建议在入院时对所有患者进行 MRSA 普遍监测，以识别和隔离 MRSA 定植患者，但仍需要进行正式的经济研究来确定这种策略的成本效益。
方法
我们开发了一种随机计算机模拟模型，以从社会和第三方支付者的角度确定在不同的 MRSA 流行率和基本繁殖率阈值下对所有入院患者进行 MRSA 监测（即对前鼻腔标本进行单次培养）的潜在经济影响。对监测培养呈阳性的患者采取隔离预防措施，以防止通过飞沫传播。未被隔离的 MRSA 定植患者可能会将 MRSA 传播给其他医院患者。
结果
当基本繁殖率为 0.25 或更高且流行率为 1%或更高时，进行普遍的 MRSA 监测具有成本效益（定义为增量成本效益比低于每质量调整生命年 50,000 美元）。事实上，当基本繁殖率为 1.5 或更高且流行率为 15%或更高、基本繁殖率为 2.0 或更高且流行率为 10%或更高、基本繁殖率为 2.5 或更高且流行率为 5%或更高时，监测是主导策略。
结论
在广泛的流行率和基本繁殖率值下，对成年患者进行普遍的 MRSA 监测似乎具有成本效益。个别医院和医疗保健系统可以将其流行情况（例如，MRSA 定植和 MRSA 传播动力学的流行率）与我们模型中的基准进行比较，以帮助确定其最佳的当地策略。
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