PharmacoEconomics & Outcomes News | 2021
Expanding MRSA prevention initiative cost effective in US
Abstract
Expanding a US Veterans Affairs (VA) program reducing methicillin-resistant Staphylococcus aureus (MRSA) transmission (National MRSA Prevention Initiative) to include hospital-onset gram-negative bacteraemia and hospitalacquired infections (HAIs) due to vancomycin-resistant Enterococci (VRE) and Clostridioides difficile would be cost effective, according to findings of a study published in Clinical Infectious Diseases. A simulation model populated with VA data on the rate of hospital-acquired MRSA and hospital-onset gram-negative bacteraemia in VA hospitals between October 2007 and September 2015 was used to evaluate the cost effectiveness and budget impact of expanding the MRSA initiative in VA hospitals to include the prevention of hospital-onset gramnegative bacteraemia and VRE and C. difficile infections, in a hypothetical inpatient population over an 8-year time horizon (fiscal years 2008–2015) from a VA perspective. The intervention included universal nasal surveillance for MRSA, isolation and contact precautions in MRSA-positive patients, and improved hand hygiene and infection control. During the study period, the intervention was estimated to avert 4761–9236 nosocomial MRSA infections, 1447–2159 cases of gram-negative bacteraemia, 3083–3602 C. difficile infections and 2075–5393 VRE infections. The estimated cost of the initiative over the 8-year period was $561 million* period, but the initiative was estimated to achieve cost savings of $165–$315 million due to prevention of nosocomial MRSA and $174–$200 million due to the prevention of gram-negative bacteremia and VRE and C. difficile infections. Estimated incremental cost-effectiveness ratios with versus without the MRSA Prevention Initiative were $12 146–$38 673 per life-year gained (LYG) when only MRSAs infection were considered, and were considerable lower when prevention of the other hospital-onset infections was included ($1354–$4369 per LYG). The overall budget impact of the initiative was estimated to range from $67 million to $195 million. In conclusion, preventing HAIs can lead to fewer infection-related deaths and lower costs among hospitalized patients. However, the resources required to undertake these prevention efforts can be costly, and the impact on a healthcare system’s budget and cost-effectiveness of the intervention depends on how many infections can be expected to be prevented, said the authors.