MRSA Initiative research calls for second look at cost-effectiveness

Though initiatives meant to prevent hospital-acquired infection come with price tags that can seem to outweigh the reduction of a single infectious disease, a new study published by Drs. Michihiko Goto and Eli Perencevich in a recent issue of Clinical Infectious Disease shows that the benefits of such initiatives may be far-reaching. (Our initial announcement about this study is posted here.)

The researchers studied data from the initiative started by the Veterans Health Administration in 2007 to combat the spread of MRSA, or drug-resistant staph infections. They focused not on the MRSA-specific prevention measures, but the initiative’s horizontal effect on gram-negative rod bacteremia, such as E. coli and Klebsiella, acquired in the hospital. Using data from 130 VHA facilities, the team found a decline of more than 40 percent in the incidence rate of those bacteremia after the initiative’s implementation.

Contributing to that decrease, said Dr. Goto, are an increased emphasis on hand hygiene, patient and faculty education, and the creation of MRSA Prevention Coordinator (MPC) positions responsible for overseeing the implementation of interventions, collecting and reporting data, and providing feedback to improve prevention.

With so many facets of the initiative, it is easy to see how costs can add up—an aspect of the MRSA initiative that Dr. Goto says has drawn some criticism. “However, if we do a cost-effectiveness analysis, we have to take those other collateral benefits into account,” he said. “Now we are adding the broader category of gram-negative bacteria, so the previous cost-effectiveness analysis needs to be repeated by including those new benefits. By including those, I think that this program is going to pay off pretty easily.”

Dr. Goto sees the as-yet unsung success of the MRSA initiative as indicative of the greater field of hospital-acquired infection prevention programs because their expense too often distracts from their success. This disconnect increases the value of time-series analyses like his and Dr. Perencevich’s, and subsequent repetition of cost-effectiveness analyses with the new data. “People can get an intuitive idea that something is good, but it is oftentimes difficult to quantify how much good it is,” Dr. Goto said. Given the recent coverage of the team’s findings, it appears the team has risen to the challenge.

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