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Cost-Effectiveness of Perioperative Mupirocin Nasal Ointment in Cardiothoracic Surgery

Published online by Cambridge University Press:  02 January 2015

Marjolein F.Q. VandenBergh ,
Jan A.J.W. Kluytmans ,
Ben A. van Hout ,
Alexander P.W.M. Maat ,
Rob J. Seerden ,
Joseph McDonnel  and
Henri A. Verbrugh
Marjolein F.Q. VandenBergh
Affiliation:
Department of Clinical Microbiology, Erasmus University, Rotterdam, The Netherlands
Jan A.J.W. Kluytmans*
Affiliation:
Department of Clinical Microbiology, Erasmus University, Rotterdam, The Netherlands
Ben A. van Hout
Affiliation:
University Hospital, Rotterdam, and the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
Alexander P.W.M. Maat
Affiliation:
Department of Thoracic Surgery, Erasmus University, Rotterdam, The Netherlands
Rob J. Seerden
Affiliation:
University Hospital, Rotterdam, and the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
Joseph McDonnel
Affiliation:
University Hospital, Rotterdam, and the Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
Henri A. Verbrugh
Affiliation:
Department of Clinical Microbiology, Erasmus University, Rotterdam, The Netherlands
*
Department of Clinical Microbiology, Ignatius Hospital, PO Box 90158, 4800 RK, Breda, The Netherlands
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Abstract

Objective:

To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery.

Design:

Cost-effectiveness analysis based on results of an intervention study with historical controls.

Setting:

University Hospital Rotterdam, a tertiary referral center for cardiac and pulmonary surgery.

Patients:

Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (control group, n=928), and between March 1, 1991, and August 1, 1992 (intervention group, n=868).

Intervention:

Perioperative nasal application of mupirocin calcium ointment started on the day before surgery, continued for 5 days, twice daily.

Results:

Postoperative costs were increased significantly in patients with a surgical-site infection (SSI), compared with uninfected patients (P<.001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval, $15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group, mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus, the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs, a noncomparative analysis of the postoperative length of stay (POLS) was performed, according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses, testing for the robustness of our conclusions, indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245.

Conclusions:

SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate, this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 12 , December 1996 , pp. 786 - 792
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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