Screening of Orthopedic Patients for MRSA May Make Economic Impact

Bruce Y. Lee, MD, MBA, from the Public Health Computational and Operations Research (PHICOR) program at the University of Pittsburgh, and colleagues report in the November issue of Infection Control and Hospital Epidemiology that routine preoperative screening and decolonization of orthopedic surgery patients may save hospitals and third-party payors money while providing health benefits.

Lee, et al. (2010) acknowledge that patients undergoing orthopedic surgery are susceptible to methicillinresistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. They sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients.

The researchers used a computer simulation model to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payor and hospital perspectives. They report that sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success.

Lee, et al. (2010) report that preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payor perspective even when MRSA prevalence was as low as 1 percent, decolonization success was as low as 25 percent, and decolonization costs were as high as $300 per patient. The researchers add that in most scenarios, this strategy was less costly and more effective than no screening. They say that from the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios they explored.

Reference: Lee BY, Wiringa AE, Bailey RR, Goyal V, Tsui B, Lewis GJ, Muder RR and Harrison LM. The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-Resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2010;31:1130-1138.