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A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients

European Journal of Clinical Microbiology & Infectious Diseases volume 33, pages 1053–1061 (2014)Cite this article

Abstract

Our objective was to model the cost-effectiveness and economic value of routine peri-operative Staphylococcus aureus screening and decolonization of lung and heart-lung transplant recipients from hospital and third-party payer perspectives. We used clinical data from 596 lung and heart-lung transplant recipients to develop a model in TreeAge Pro 2009 (Williamsport, MA, USA). Sensitivity analyses varied S. aureus colonization rate (5–15 %), probability of infection if colonized (10–30 %), and decolonization efficacy (25–90 %). Data were collected from the Cardiothoracic Transplant Program at the University of Pittsburgh Medical Center. Consecutive lung and heart-lung transplant recipients from January 2006 to December 2010 were enrolled retrospectively. Baseline rates of S. aureus colonization, infection and decolonization efficacy were 9.6 %, 36.7 %, and 31.9 %, respectively. Screening and decolonization was economically dominant for all scenarios tested, providing more cost savings and health benefits than no screening. Savings per case averted (2012 $US) ranged from $73,567 to $133,157 (hospital perspective) and $10,748 to $16,723 (third party payer perspective), varying with the probability of colonization, infection, and decolonization efficacy. Using our clinical data, screening and decolonization led to cost savings per case averted of $240,602 (hospital perspective) and averted 6.7 S. aureus infections (4.3 MRSA and 2.4 MSSA); 89 patients needed to be screened to prevent one S. aureus infection. Our data support routine S. aureus screening and decolonization of lung and heart-lung transplant patients. The economic value of screening and decolonization was greater than in previous models of other surgical populations.

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Acknowledgments

This study was supported by the National Institute of General Medical Sciences Models of Infectious Disease Agent Study (MIDAS) grant 5U54GM088491-02, the National Institute of Allergy and Infectious Diseases grant 1RC4AI092327-01, and the Pennsylvania Department of Health. The authors have no conflicts of interest or relevant disclosures.

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Affiliations

  1. Department of Medicine, University of Pittsburgh, 3550 Terrace Street, Scaife Hall 867, Pittsburgh, PA, 15261, USA

    C. J. Clancy, M. H. Nguyen & R. K. Shields

  2. Pittsburgh VA Healthcare System, Pittsburgh, VA, USA

    C. J. Clancy

  3. Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA

    S. M. Bartsch, D. R. Stuckey & B. Y. Lee

  4. International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    B. Y. Lee

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  1. C. J. Clancy
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Correspondence to C. J. Clancy.

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Clancy, C.J., Bartsch, S.M., Nguyen, M.H. et al. A computer simulation model of the cost-effectiveness of routine Staphylococcus aureus screening and decolonization among lung and heart-lung transplant recipients. Eur J Clin Microbiol Infect Dis 33, 1053–1061 (2014). https://doi.org/10.1007/s10096-013-2046-y

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  • DOI: https://doi.org/10.1007/s10096-013-2046-y

Keywords

  • Colonization Rate
  • Lung Transplant Recipient
  • Peripherally Insert Central Catheter
  • Aureus Infection
  • Hospital Perspective