Gidengil Courtney A, Gay Charlene, Huang Susan S, Platt Richard, Yokoe Deborah, Lee Grace M
1RAND Corporation,Boston,Massachusetts.
3Center for Child Health Care Studies,Harvard Pilgrim Health Care Institute and Harvard Medical School,Boston,Massachusetts.
Infect Control Hosp Epidemiol. 2015 Jan;36(1):17-27. doi: 10.1017/ice.2014.12.
OBJECTIVE To create a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. DESIGN Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. PATIENTS AND SETTING Hypothetical cohort of 10,000 adult patients admitted to a US intensive care unit. METHODS We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures; (2) active surveillance cultures plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate baths; (5) universal decolonization; (6) UCP + chlorhexidine gluconate baths; and (7) UCP+decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. RESULTS A total of 1989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared with all strategies except UCP+decolonization and UCP+chlorhexidine gluconate. UCP+decolonization was more effective than universal decolonization but would cost $2469 per colonization averted and $9007 per infection averted. If MRSA colonization prevalence decreases from 12% to 5%, active surveillance cultures plus selective decolonization becomes the least expensive strategy. CONCLUSIONS Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.
目的 创建一个国家政策模型，以评估多种基于医院的策略在预防耐甲氧西林金黄色葡萄球菌（MRSA）传播和感染方面的预期成本效益。设计 使用马尔可夫微观模拟模型进行成本效益分析，该模型模拟了MRSA获得和感染的自然史。患者和环境 假设为10000名入住美国重症监护病房的成年患者队列。方法 我们从医院角度将7种策略与标准预防措施进行了比较：（1）主动监测培养；（2）主动监测培养加选择性去定植；（3）普遍接触预防措施（UCP）；（4）普遍使用葡萄糖酸洗必泰沐浴；（5）普遍去定植；（6）UCP + 葡萄糖酸洗必泰沐浴；（7）UCP + 去定植。对于每种策略，都考虑了疗效和依从性。感兴趣的结果包括：（1）避免的MRSA定植；（2）避免的MRSA感染；（3）避免每例定植的增量成本；（4）避免每例感染的增量成本。结果 在标准预防措施下，每10000名患者中总共发生了1989例定植和544例MRSA侵袭性感染。普遍去定植是成本最低的策略，与除UCP + 去定植和UCP + 葡萄糖酸洗必泰之外的所有策略相比更有效。UCP + 去定植比普遍去定植更有效，但避免每例定植的成本为2469美元，避免每例感染的成本为9007美元。如果MRSA定植患病率从12%降至5%，主动监测培养加选择性去定植将成为成本最低的策略。结论 普遍去定植具有成本节约效益，可预防44%的MRSA定植病例和45%的MRSA感染病例。我们的模型为决策者在多种可用的基于医院的预防MRSA传播策略之间进行选择提供了有用的指导。
