{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T17:18:03Z","timestamp":1773076683602,"version":"3.50.1"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"Supplement_1","funder":[{"DOI":"10.13039\/100007217","name":"VA Health Services Research and Development Service","doi-asserted-by":"publisher","award":["CIN 13\u2013414"],"award-info":[{"award-number":["CIN 13\u2013414"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"VA Health Services Research and Development Service","doi-asserted-by":"publisher","award":["CDA 11\u2013210"],"award-info":[{"award-number":["CDA 11\u2013210"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,29]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In October 2007, Veterans Affairs (VA) launched a nationwide effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) transmission called the National MRSA Prevention Initiative. Although the initiative focused on MRSA, recent evidence suggests that it also led to a significant decrease in hospital-onset (HO) gram-negative rod (GNR) bacteremia, vancomycin-resistant Enterococci (VRE), and Clostridioides difficile infections. The objective of this analysis was to evaluate the cost-effectiveness and the budget impact of the initiative taking into account MRSA, GNR, VRE, and C. difficile infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We developed an economic model using published data on the rate of MRSA hospital-acquired infections (HAIs) and HO-GNR bacteremia in the VA from October 2007 to September 2015, estimates of the attributable cost and mortality of these infections, and the costs associated with the intervention obtained through a microcosting approach. We explored several different assumptions for the rate of infections that would have occurred if the initiative had not been implemented. Effectiveness was measured in life-years (LYs) gained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We found that during fiscal years 2008\u20132015, the initiative resulted in an estimated 4761\u20139236 fewer MRSA HAIs, 1447\u20132159 fewer HO-GNR bacteremia, 3083\u20133602 fewer C. difficile infections, and 2075\u20135393 fewer VRE infections. The initiative itself was estimated to cost $561 million over this 8-year period, whereas the cost savings from prevented MRSA HAIs ranged from $165 to $315 million and from prevented HO-GNR bacteremia, CRE and C. difficile infections ranged from $174 to $200 million. The incremental cost-effectiveness of the initiative ranged from $12 146 to $38 673\/LY when just including MRSA HAIs and from $1354 to $4369\/LY when including the additional pathogens. The overall impact on the VA\u2019s budget ranged from $67 to$195 million.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An MRSA surveillance and prevention strategy in VA may have prevented a substantial number of infections from MRSA and other organisms. The net increase in cost from implementing this strategy was quite small when considering infections from all types of organisms. Including spillover effects of organism-specific prevention efforts onto other organisms can provide a more comprehensive evaluation of the costs and benefits of these interventions.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciaa1591","type":"journal-article","created":{"date-parts":[[2020,11,25]],"date-time":"2020-11-25T04:40:53Z","timestamp":1606279253000},"page":"S50-S58","source":"Crossref","is-referenced-by-count":13,"title":["Expanding an Economic Evaluation of the Veterans Affairs (VA) Methicillin-resistant<i>Staphylococcus aureus<\/i>(MRSA) Prevention Initiative to Include Prevention of Infections From Other Pathogens"],"prefix":"10.1093","volume":"72","author":[{"given":"Richard E","family":"Nelson","sequence":"first","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"name":"Iowa City Veterans Affairs Health Care System, Iowa City, IA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew H","family":"Samore","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Jones","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa W","family":"Stevens","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin E","family":"Evans","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Lexington, Kentucky, USA"},{"name":"Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA"},{"name":"MRSA\/MDRO Program, National Infectious Diseases Service, Veterans Health Administration, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin L","family":"Schweizer","sequence":"additional","affiliation":[{"name":"Iowa City Veterans Affairs Health Care System, Iowa City, IA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eli N","family":"Perencevich","sequence":"additional","affiliation":[{"name":"Iowa City Veterans Affairs Health Care System, Iowa City, IA"},{"name":"Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"Rubin","sequence":"additional","affiliation":[{"name":"Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,1,29]]},"reference":[{"key":"2021012909151280600_CIT0001","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1056\/NEJMoa1007474","article-title":"Veterans Affairs 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