Active surveillance and decolonization of methicillin-resistant Staphylococcus aureus on admission to neonatal intensive care units in Hong Kong: a cost-effectiveness analysis.

OBJECTIVE

To examine potential clinical outcomes and cost of active methicillin-resistant Staphylococcus aureus (MRSA) surveillance with and without decolonization in neonatal intensive care units (NICUs) from the perspective of healthcare providers in Hong Kong.

DESIGN

Decision analysis modeling.

SETTING

NICU.

PATIENTS

Hypothetical cohort of patients admitted to an NICU.

METHODS

We designed a decision tree to simulate potential outcomes of active MRSA surveillance with and without decolonization in patients admitted to an NICU. Outcome measures included total direct medical cost per patient, MRSA infection rate, and MRSA-associated mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.

RESULTS

In the base-case analysis, active surveillance plus decolonization showed a lower expected MRSA infection rate (0.911% vs. 1.759%), MRSA-associated mortality rate (0.223% vs. 0.431%), and total cost per patient (USD 47,294 vs. USD 48,031) compared with active surveillance alone. Sensitivity analyses showed that active surveillance plus decolonization cost less and had lower event rates if the incidence risk ratio of acquiring MRSA infections in carriers after decolonization was less than 0.997. In 10,000 Monte Carlo simulations, active surveillance plus decolonization was significantly less costly than active surveillance alone 99.9% of the time, and both the MRSA infection rate and the MRSA-associated mortality rate were significantly lower 99.9% of the time.

CONCLUSIONS

Active surveillance plus decolonization for patients admitted to NICUs appears to be cost saving and effective in reducing the MRSA infection rate and the MRSA-associated mortality rate if addition of decolonization to active surveillance reduces the risk of MRSA infection.