Costs of outpatient and inpatient MRSA screening and treatment strategies for patients at elective hospital admission – a decision tree analysis

Hutzschenreuter, Luise, et al. “Costs of Outpatient and Inpatient MRSA Screening and Treatment Strategies for Patients at Elective Hospital Admission – a Decision Tree Analysis.” Antimicrobial Resistance and Infection Control, vol. 7, 2018, p. 147. PubMed, doi:10.1186/s13756-018-0442-x.

This article discusses the various costs associated with testing patients for multidrug-resistant organisms (MDRO), specifically Methicillin-Resistant S. aureus (MRSA) (pg 1).

Patients were screened with a swab test if they possessed one or more of the risk factors for MRSA (pg 2).

The study accounted for personnel costs, material costs, and laboratory costs of both inpatient and outpatient screenings over a two-week period (pg 2). To evaluate theses costs, a decision tree was constructed, which included the likelihood of having a risk factor and whether the patient tests positive for MRSA (pg 5).

Page 5
  • Path A: Outpatient, No risk factors; €0.48
    • Risk assessment
  • Path B: Outpatient. Risk factors, Negative test; €7.57
    • Risk assessment, Screening
  • Path C: Outpatient. Risk factors, Positive test; €99.34
    • Risk assessment, Screening, Outpatient Decolonization (at home)
  • Path D: Inpatient. No risk factors; €0.48
    • Risk assessment
  • Path E: Inpatient. Risk factors, Negative test; €664.29
    • Risk assessment, Screening, Opportunity Costs for Preemptive Isolation (2 days)
  • Path F: Inpatient. Risk factors, Positive test; €7342.62
    • Risk assessment, Screening, Opportunity Costs for Preemptive Isolation (2 days), Opportunity Costs for Actual Isolation (~15 days), Inpatient Decolonization

Outpatient Expected Cost: €8.24 (pg 5)

Inpatient Expected Cost €672.51 (pg 5)

This shows, from a general decision making standpoint, that it advantageous to conduct pre-admission screening, so as to avoid the additional costs of inpatient isolation and decolonization (pg 7).

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