Response to McKinnell et al's original article "cost-benefit analysis from the hospital perspective of universal active screening followed by contact precautions for methicillin-resistant Staphylococcus aureus carriers"

In a 2011 US study, targeted screening was associated with lower costs and better outcomes than a policy of no screening, whereas universal screening was associated with an average cost-effectiveness ratio of €11,769 per MRSA infection.6 In a second cost-effectiveness analysis, targeted screening strategies were found to be more cost-effective than universal screening, with incremental cost-effectiveness ratios of €3,227 to €28,507, depending on the prevalence rate and testing used, compared with €103,169 to €183,269 per additional infection averted for universal screening.4 Finally, a US prospective study comparing the clinical effectiveness and cost benefit of universal versus targeted screening reported a benefit-to-cost ratio of 0.50, indicating that for every additional euro spent on universal versus targeted screening, only €0.40 could be recovered in avoided costs due to a reduction in MRSA healthcare-associated infection.7 The control of MRSA is a multidisciplinary task involving surveillance, patient screening, decolonization, isolation and/or the cohorting of patients, environmental decontamination, antimicrobial stewardship, maintenance of adequate staffing levels, and hand hygiene. The control measures have additional merits because they increase the awareness of the importance of all healthcare-associated infections and their implementation decreases other healthcare-associated infections.9 However, MRSA control measures encompass a wide range of interventions, the efficacy and cost of some of which are dependent on prevalence rates, local resistance patterns, the characteristics of the patient population, and the hospital facilities, all of which will vary from country to country. Because the MRSA prevalence rate in Ireland is higher than in the United Kingdom and in other Northern European countries, MRSA prevention and control is very relevant in the potential efficient use of resources. [...]the evidence shows that screening, whether universal or targeted, is better than no screening, resulting in fewer MRSA infections.