Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission - a decision tree analysis.
Background
Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective.


Methods
A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented.


Results
The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51.


Conclusion
The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.
['Hutzschenreuter|Luise|L|0000-0003-0388-0579', 'Flessa|Steffen|S|', 'Dittmann|Kathleen|K|', 'Hübner|Nils-Olaf|NO|']
D000289:Admitting Department, Hospital D000900:Anti-Bacterial Agents D003362:Cost-Benefit Analysis D003365:Costs and Cost Analysis D003428:Cross Infection D003663:Decision Trees D024901:Drug Resistance, Multiple, Bacterial D006760:Hospitalization D006801:Humans D007297:Inpatients D007362:Intensive Care Units D007902:Length of Stay D008403:Mass Screening D055624:Methicillin-Resistant Staphylococcus aureus D010045:Outpatients D013203:Staphylococcal Infections
Costs Decision tree analysis Outpatient screening Decolonization Expected costs Admission screening Methicillin-resistant Staphylococcus aureus