Universal MRSA screening in Newborns
We are all just digging out of our email (and other) piles created while spending a week in Atlanta at the Decennial. In doing so, I just came across this abstract (or here) that I must have missed while there. I found the economic evaluation interesting. Researchers at Loyola University completed a study on 2031 newborn-mother pairs during a 21-month study. The study only detected four positive neonates and 3 positive moms. The testing cost their health system $40,000/MRSA detected. Of note, the authors suggested that this level of cost was not cost-effective but it is pretty clear they didn't using the US Panel for Cost-Effectiveness (1996) criteria to make such a claim.
While this does seem like a lot of money to pay to detect an MRSA colonization, what it really points out is that these types of studies shouldn't be used to make any medical decisions. The main reason is that unless the hospital you work at has the same population prevalence of MRSA colonization, the results can't be applied to your hospital. Even the much talked about cluster-randomized trials are basically useless for informing medical decisions around what is the best method to control transmissible infections in a specific setting. That is of course, unless these trials intervene in 30+ hospitals that are similar to yours, which isn't going to happen. There's just too much variability between hospitals in terms of size, length of stay and MRSA prevalence. The only way to properly analyze MRSA transmission and prevention is through the use of mathematical simulation models which allow for variable hospital characteristics and MRSA prevalence. If these models use the best available data, they could greatly inform medical decision makers.
While this does seem like a lot of money to pay to detect an MRSA colonization, what it really points out is that these types of studies shouldn't be used to make any medical decisions. The main reason is that unless the hospital you work at has the same population prevalence of MRSA colonization, the results can't be applied to your hospital. Even the much talked about cluster-randomized trials are basically useless for informing medical decisions around what is the best method to control transmissible infections in a specific setting. That is of course, unless these trials intervene in 30+ hospitals that are similar to yours, which isn't going to happen. There's just too much variability between hospitals in terms of size, length of stay and MRSA prevalence. The only way to properly analyze MRSA transmission and prevention is through the use of mathematical simulation models which allow for variable hospital characteristics and MRSA prevalence. If these models use the best available data, they could greatly inform medical decision makers.
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