Purpose: The research objectives of our health technology assessment were to evaluate the screening accuracy and clinical and cost-effectiveness of polymerase chain reaction (PCR) testing compared with conventional screening tests (i.e., chromogenic agar) and no screening for methicillin resistant Staphylococcus aureus (MRSA) in hospitalized patients. PCR tool kits included in our assessment were BD GeneOhm MRSA (BD Diagnostics) and Genexpert Dx System-Xpert MRSA (Cepheid).
Method: A systematic review and meta-analysis of the clinical evidence were conducted. A probabilistic economic analysis that compared no screening with chromogenic agar and PCR tests, and four deterministic sensitivity analyses were performed. To allow hospital authorities to estimate the most cost-effective screening strategy for MRSA screening in their setting, a MRSA calculator tool based on our economic analysis was developed
Result: MRSA screening with PCR resulted in lower turnaround time and number of isolation days compared with chromogenic agar. Based the clinical evidence, PCR showed high accuracy rates versus chromogenic agar. Compared with no screening, chromogenic agar yielded the lowest cost per MRSA colonization case avoided without isolation precaution, whereas PCR (BD GeneOhm MRSA) was the most effective and least costly strategy with isolation precaution compared with chromogenic agar and Xpert MRSA.
Conclusion: PCR demonstrated high screening test accuracy and was clinically effective versus chromogenic agar. The cost-effectiveness of PCR compared with chromogenic agar is largely dependent on the ability to realize cost savings from the shorter duration of the isolation precaution. The results suggest that cost-effectiveness is responsive to the costs of patient isolation and the number and proportion of high-risk contacts per visit between a health care worker and a patient and to changes in the MRSA prevalence rate at admission without isolation precaution. Current guidelines recommend using MRSA screening in hospitals that targets high-risk patient populations. Several individual and societal ethical issues, such as the trade-off between doing good and not doing harm, require consideration by health care institutions that conduct MRSA screening.
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