Epidemiologic and economic effect of methicillin-resistant staphylococcus aureus in obstetrics

OBJECTIVE: To quantify the epidemiologic and economic burden of methicillin-resistant Staphylococcus aureus (MRSA) infections in the obstetric population, identify main factors influencing the magnitude of disease, and evaluate the cost-effectiveness of MRSA screening and decolonization. METHODS: A cost-effectiveness decision analytic model was constructed for estimations from both the societal and third party-payer perspectives. Probabilities were derived from prior studies when available. Cost data came from the Healthcare Cost and Utilization Project, medication wholesale prices, and the Centers for Medicare & Medicaid Services. Sensitivity analysis was conducted to assess the effect of variables across a range of values. RESULTS: Approximately 14,294 pregnant or postpartum women experience an invasive MRSA infection in the United States annually. The majority of invasive MRSA infections are mastitis (n=8,880). The annual economic effect of MRSA infections is projected to be approximately $8.7 million and approximately $8.0 million from the societal and payer perspectives, respectively. Sensitivity analyses demonstrate that the prevalence of MRSA, incidence of mastitis, and rate of cesarean deliveries were key driving factors for the estimations. CONCLUSION: Methicillin-resistant S aureus is an important emerging pathogen responsible for a modest burden of puerperal infections and associated costs. Universal screening and decolonization efforts do not currently seem to be cost-effective.