Expanding an Economic Evaluation of the Veterans Affairs (VA) Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative to Include Prevention of Infections From Other Pathogens

Richard E Nelson; Michihiko Goto; Matthew H Samore; Makoto Jones; Vanessa W Stevens; Martin E Evans; Marin L Schweizer; Eli N Perencevich; Michael A Rubin

doi:10.1093/cid/ciaa1591

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Expanding an Economic Evaluation of the Veterans Affairs (VA) Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative to Include Prevention of Infections From Other Pathogens

Journal article

Open access

Peer reviewed

Expanding an Economic Evaluation of the Veterans Affairs (VA) Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative to Include Prevention of Infections From Other Pathogens

Richard E Nelson, Michihiko Goto, Matthew H Samore, Makoto Jones, Vanessa W Stevens, Martin E Evans, Marin L Schweizer, Eli N Perencevich and Michael A Rubin

Clinical infectious diseases, Vol.72(Suppl 1), pp.S50-S58

01/29/2021

DOI: 10.1093/cid/ciaa1591

PMID: 33512526

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Abstract

In October 2007, Veterans Affairs (VA) launched a nationwide effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission called the National MRSA Prevention Initiative. Although the initiative focused on MRSA, recent evidence suggests that it also led to a significant decrease in hospital-onset (HO) gram-negative rod (GNR) bacteremia, vancomycin-resistant Enterococci (VRE), and Clostridioides difficile infections. The objective of this analysis was to evaluate the cost-effectiveness and the budget impact of the initiative taking into account MRSA, GNR, VRE, and C. difficile infections. We developed an economic model using published data on the rate of MRSA hospital-acquired infections (HAIs) and HO-GNR bacteremia in the VA from October 2007 to September 2015, estimates of the attributable cost and mortality of these infections, and the costs associated with the intervention obtained through a microcosting approach. We explored several different assumptions for the rate of infections that would have occurred if the initiative had not been implemented. Effectiveness was measured in life-years (LYs) gained. We found that during fiscal years 2008-2015, the initiative resulted in an estimated 4761-9236 fewer MRSA HAIs, 1447-2159 fewer HO-GNR bacteremia, 3083-3602 fewer C. difficile infections, and 2075-5393 fewer VRE infections. The initiative itself was estimated to cost $561 million over this 8-year period, whereas the cost savings from prevented MRSA HAIs ranged from $165 to $315 million and from prevented HO-GNR bacteremia, CRE and C. difficile infections ranged from $174 to $200 million. The incremental cost-effectiveness of the initiative ranged from $12 146 to $38 673/LY when just including MRSA HAIs and from $1354 to $4369/LY when including the additional pathogens. The overall impact on the VA's budget ranged from $67 to$195 million. An MRSA surveillance and prevention strategy in VA may have prevented a substantial number of infections from MRSA and other organisms. The net increase in cost from implementing this strategy was quite small when considering infections from all types of organisms. Including spillover effects of organism-specific prevention efforts onto other organisms can provide a more comprehensive evaluation of the costs and benefits of these interventions.

Staphylococcal Infections - epidemiology

Cross Infection - prevention & control

Veterans

Cost-Benefit Analysis

Humans

Clostridioides difficile

Staphylococcal Infections - prevention & control

Cross Infection - epidemiology

Methicillin-Resistant Staphylococcus aureus

Details

Title: Subtitle: Expanding an Economic Evaluation of the Veterans Affairs (VA) Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative to Include Prevention of Infections From Other Pathogens
Creators: Richard E Nelson - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Michihiko Goto - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Matthew H Samore - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Makoto Jones - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Vanessa W Stevens - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Martin E Evans - MRSA/MDRO Program, National Infectious Diseases Service, Veterans Health Administration, Lexington, Kentucky, USA
Marin L Schweizer - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Eli N Perencevich - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
Michael A Rubin - Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.72(Suppl 1), pp.S50-S58
Publisher: United States
DOI: 10.1093/cid/ciaa1591
PMID: 33512526
ISSN: 1058-4838
eISSN: 1537-6591
Grant note: DOI: 10.13039/100007217, name: VA Health Services Research and Development Service, award: CIN 13–414, CDA 11–210
Language: English
Date published: 01/29/2021
Academic Unit: Infectious Diseases; Epidemiology; Internal Medicine
Record Identifier: 9984077786502771

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