TY - JOUR
T1 - Methicillin-resistant staphylococcus aureus prevention strategies in the ICU
T2 - A clinical decision analysis
AU - Ziakas, Panayiotis D.
AU - Zacharioudakis, Ioannis M.
AU - Zervou, Fainareti N.
AU - Mylonakis, Eleftherios
N1 - Publisher Copyright:
Copyright © 2015 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Objectives: ICUs are a major reservoir of methicillin-resistant Staphylococcus aureus. Our aim was to estimate costs and effectiveness of methicillin-resistant Staphylococcus aureus prevention policies. Design and Interventions: We evaluated three up-to-date methicillin- resistant Staphylococcus aureus prevention policies, namely, 1) nasal screening and contact precautions of methicillin-resistant Staphylococcus aureus-positive patients; 2) nasal screening, contact precautions, and decolonization (targeted decolonization) of methicillin-resistant Staphylococcus aureus carriers; and 3) universal decolonization without screening. We implemented a decision-analytic model with deterministic and probabilistic analyses. Methicillin-resistant Staphylococcus aureus infections averted, quality-adjusted life years gained, and incremental costeffectiveness ratios were calculated. Cost-effectiveness planes and acceptability curves were plotted for various willingness-topay thresholds to address uncertainty. Measurements and Main Results: At base-case scenario, universal decolonization was the dominant strategy; it averted 1.31% and 1.59% of methicillin-resistant Staphylococcus aureus infections over targeted decolonization and screening and contact precautions, respectively, and saved $16,203/quality-adjusted life year over targeted decolonization and 14,562/quality-adjusted life year over screening and contact precautions. Results were robust in sensitivity analysis for a wide range of input variables. In probabilistic analysis, universal decolonization increased qualityadjusted life years by 1.06% (95% CI, 1.02-1.09) over targeted decolonization and by 1.29% (95% CI, 1.24-1.33) over screening and contact precautions; universal decolonization resulted in average savings of $172 (95% CI, $168-$175) and $189 (95% CI, $185-$193) over targeted decolonization and screening and contact precautions, respectively. With willingness-to-pay threshold per quality-adjusted life year gained ranging from $0 to $50,000, universal decolonization was dominant over targeted decolonization in 67.5-75.4% and dominant over screening and contact precautions in 66.0-75.4%. Conclusions: In the ICU setting, universal decolonization outperforms the other two strategies and is likely to be cost-effective even at low willingness-to-pay thresholds. Assuming 700 annual ICU admissions in an average 12-bed ICU, the projected annual savings reach $129,500 to $135,100. (Crit Care Med 2015; 43:382-393).
AB - Objectives: ICUs are a major reservoir of methicillin-resistant Staphylococcus aureus. Our aim was to estimate costs and effectiveness of methicillin-resistant Staphylococcus aureus prevention policies. Design and Interventions: We evaluated three up-to-date methicillin- resistant Staphylococcus aureus prevention policies, namely, 1) nasal screening and contact precautions of methicillin-resistant Staphylococcus aureus-positive patients; 2) nasal screening, contact precautions, and decolonization (targeted decolonization) of methicillin-resistant Staphylococcus aureus carriers; and 3) universal decolonization without screening. We implemented a decision-analytic model with deterministic and probabilistic analyses. Methicillin-resistant Staphylococcus aureus infections averted, quality-adjusted life years gained, and incremental costeffectiveness ratios were calculated. Cost-effectiveness planes and acceptability curves were plotted for various willingness-topay thresholds to address uncertainty. Measurements and Main Results: At base-case scenario, universal decolonization was the dominant strategy; it averted 1.31% and 1.59% of methicillin-resistant Staphylococcus aureus infections over targeted decolonization and screening and contact precautions, respectively, and saved $16,203/quality-adjusted life year over targeted decolonization and 14,562/quality-adjusted life year over screening and contact precautions. Results were robust in sensitivity analysis for a wide range of input variables. In probabilistic analysis, universal decolonization increased qualityadjusted life years by 1.06% (95% CI, 1.02-1.09) over targeted decolonization and by 1.29% (95% CI, 1.24-1.33) over screening and contact precautions; universal decolonization resulted in average savings of $172 (95% CI, $168-$175) and $189 (95% CI, $185-$193) over targeted decolonization and screening and contact precautions, respectively. With willingness-to-pay threshold per quality-adjusted life year gained ranging from $0 to $50,000, universal decolonization was dominant over targeted decolonization in 67.5-75.4% and dominant over screening and contact precautions in 66.0-75.4%. Conclusions: In the ICU setting, universal decolonization outperforms the other two strategies and is likely to be cost-effective even at low willingness-to-pay thresholds. Assuming 700 annual ICU admissions in an average 12-bed ICU, the projected annual savings reach $129,500 to $135,100. (Crit Care Med 2015; 43:382-393).
KW - Cost-effectiveness
KW - Infection
KW - Intensive care
KW - Methicillin resistant
KW - Methicillin-resistant staphylococcus aureus
UR - http://www.scopus.com/inward/record.url?scp=84925361778&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84925361778&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000000711
DO - 10.1097/CCM.0000000000000711
M3 - Article
C2 - 25377019
AN - SCOPUS:84925361778
VL - 43
SP - 382
EP - 393
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 2
ER -