Impact of screening all high-risk patients at hospital admission for methicillin-resistant <i>Staphylococcus aureus</i> in Spain: a cost-consequence analysis

Aim Screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization by culture-based or molecular-based methods in hospitals identifies patients for decolonization, mitigating transmission. This study aimed at quantifying the impact of expanding MRSA screening at hospital admission in Spain to all patients at high risk of being colonized with MRSA (HRP), using on-demand molecular PCR instead of culture.Methods In the base case, HRP were those admitted to coronary, burn, or hemodialysis units, hematology or oncology medical departments, intensive care units (ICU) or specified surgical departments. A decision-tree model was developed to compare MRSA screening strategies: S1 was preventive contact precautions (PrevCP) + screening with on-demand molecular PCR (Xpert MRSA NxGFootnotei) applied to all HRP; S2 was PrevCP + culture-based screening applied to all HRP; S3 was current clinical practice in Spain of PrevCP + culture-based screening for ICU-admitted patients only. A 60-day time horizon was considered, and the hospital perspective was adopted. Model input values were obtained from publicly available data and expert opinion.Results In a hospital with 20,000 annual admissions, S1 versus S2 was estimated to generate 7.4 more MRSA-positive tests, 4.3 more successful decolonizations, and 0.8 fewer MRSA-related infections. The increase in total testing costs (+61,447.4€) was more than compensated by savings in excess cost due to PrevCP (−792,211.0€) and infection-related costs (−18,271.2€). Estimated total cost savings with S1 versus S2 were 748,971.2€ (−438.8€/HRP tested). Screening with S1 versus S3 increased the number of HRP tested (1,524.0), identified 113.3 more MRSA-positive tests, with 12.6 fewer MRSA-related infections, and 3.4 fewer deaths. Estimated total cost savings with S1 versus S3 were 272,118.5€ (−3,278.0€/HRP tested).Conclusion Screening all HRP with Xpert MRSA NxG in Spain compared with culture and current clinical practice could generate savings from a hospital perspective and prevent infections, nosocomial colonization, and mortality.