Implementation Impact of Methicillin-resistant Staphylococcus aureus (MRSA) Rapid Molecular Testing on Hospital-Related Quality and Cost of Care.

Background: The implementation of proactive screening has reduced methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital settings. This study evaluated the health and cost implications of the utilization of a rapid PCR-based testing strategy compared to conventional strategies for MRSA control.

Methods: A cost-consequence analysis incorporating conventional interventional and infection-related expenditures was developed to estimate the health and economic impact of rapid PCR-based screening compared to no screening, universal decolonization, and culture-based screening from a U.S. hospital perspective. The analysis included patients hospitalized in general wards at risk of MRSA infection over a 30-day time horizon. The model inputs were informed by the published literature. Sensitivity and scenario analyses were conducted to examine the impact of key parameters and assumptions.

Results: In a 1,000-patient cohort, compared to culture-based screening with and without pre-emptive isolation, the rapid PCR-based screening saved $11,842,498 and $5,625,278, respectively, in total costs and reduced health outcomes while resulting in fewer infections, deaths, and onward transmissions compared to conventional culture screening without pre-emptive isolation. Compared to universal decolonization, the rapid PCR-based strategy saved $12,353,893 in total costs. Although the total costs increased for molecular screening due to higher bed day costs compared to no active screening, the rapid PCR-based strategy averted infections, subsequent deaths, and onward transmissions. Sensitivity and scenario analyses confirmed the robustness of these findings.

Conclusions: Compared to other interventional strategies to reduce MRSA-related sequelae in the hospital setting routine testing with rapid PCR-based screening shows potential for improved health outcomes and cost savings.