Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.
Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.
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在重症监护病房中，防止耐甲氧西林金黄色葡萄球菌的传播和感染的策略的成本效益。
DOI：
10.1017/ice.2014.12
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发表时间：
2015-01
影响因子：
4.5
通讯作者：
Lee, Grace M.
中科院分区：
文献类型：
--
作者：
Gidengil, Courtney A.;Gay, Charlene;Huang, Susan S.;Platt, Richard;Yokoe, Deborah;Lee, Grace M.
我们创建了一个国家政策模型，以评估预防MRSA传播和感染的多种基于医院的策略的预计成本效益。使用马尔可夫微观模拟模型进行成本效益分析，该模型模拟MRSA获得和感染的自然历史。假设有10，000名成年患者入住美国ICU。我们从医院的角度比较了7种策略与标准预防措施：（1）主动监测培养（ASC）;（2）ASC加选择性去殖民化;（3）通用接触预防措施（UCP）;（4）通用葡萄糖酸氯己定（CHG）浴;（5）通用去殖民化;（6）UCP + CHG浴;（7）UCP+去殖民化。对于每种策略，均考虑了疗效和依从性。关注的结果为：（1）避免MRSA定植;（2）避免MRSA感染;（3）避免每次定植的增量成本;（4）避免每次感染的增量成本。在标准预防措施下，每10，000名患者发生1，989例定植和544例MRSA侵袭性感染。普遍非殖民化是成本最低的战略，与除UCP+非殖民化和UCP + CHG之外的所有战略相比，都更有效。UCP+非殖民化比普遍非殖民化更有效，但每避免一次殖民化将花费2 469美元，每避免一次感染将花费9 007美元。如果MRSA定植率从12%下降到5%，ASC加选择性去定植成为最便宜的策略。普遍去殖民化可以节省成本，防止44%的MRSA定植病例和45%的MRSA感染病例。我们的模型为决策者在多种可用的基于医院的策略之间进行选择以预防MRSA传播提供了有用的指导。
We created a national policy model to evaluate the projected cost-effectiveness of multiple hospital-based strategies to prevent MRSA transmission and infection. Cost-effectiveness analysis using a Markov microsimulation model that simulates the natural history of MRSA acquisition and infection. Hypothetical cohort of 10,000 adult patients admitted to a U.S. ICU. We compared 7 strategies to standard precautions using a hospital perspective: (1) active surveillance cultures (ASC); (2) ASC plus selective decolonization; (3) universal contact precautions (UCP); (4) universal chlorhexidine gluconate (CHG) baths; (5) universal decolonization; (6) UCP + CHG baths; and (7) UCP + decolonization. For each strategy, both efficacy and compliance were considered. Outcomes of interest were: (1) MRSA colonization averted; (2) MRSA infection averted; (3) incremental cost per colonization averted; (4) incremental cost per infection averted. 1,989 cases of colonization and 544 MRSA invasive infections occurred under standard precautions per 10,000 patients. Universal decolonization was the least expensive strategy and was more effective compared to all strategies except UCP + decolonization and UCP + CHG. UCP + decolonization was more effective than universal decolonization, but would cost $2,469 per colonization averted and $9,007 per infection averted. If MRSA colonization prevalence drops from 12% to 5%, ASC plus selective decolonization becomes the least expensive strategy. Universal decolonization is cost-saving, preventing 44% of cases of MRSA colonization and 45% of cases of MRSA infection. Our model provides useful guidance for decision makers choosing between multiple available hospital-based strategies to prevent MRSA transmission.
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检测后一年，高危患者的金黄色葡萄球菌感染和住院。
影响因子：
3.7
作者：
Huang SS;Hinrichsen VL;Datta R;Spurchise L;Miroshnik I;Nelson K;Platt R
通讯作者：
Platt R
影响因子：
4.5
作者：
Ben-David, Debby;Novikov, Ilya;Mermel, Leonard A.
通讯作者：
Mermel, Leonard A.
影响因子：
11.8
作者：
Golan, Y;Doron, S;Snydman, DR
通讯作者：
Snydman, DR
影响因子：
158.5
作者：
Huang, Susan S.;Septimus, Edward;Platt, Richard
通讯作者：
Platt, Richard
影响因子：
4.5
作者：
Cosgrove, SE;Qi, YL;Carmeli, Y
通讯作者：
Carmeli, Y