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Cost-Effectiveness of Preoperative Nasal Mupirocin Treatment in Preventing Surgical Site Infection in Patients Undergoing Total Hip and Knee Arthroplasty: A Cost-Effectiveness Analysis

Published online by Cambridge University Press:  02 January 2015

Xan F. Courville ,
Ivan M. Tomek ,
Kathryn B. Kirkland ,
Marian Birhle ,
Stephen R. Kantor  and
Samuel R. G. Finlayson
Xan F. Courville*
Affiliation:
Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire The Dartmouth Institute, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Ivan M. Tomek
Affiliation:
Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Kathryn B. Kirkland
Affiliation:
Department of Infectious Diseases, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire The Dartmouth Institute, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Marian Birhle
Affiliation:
The Dartmouth Institute, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Stephen R. Kantor
Affiliation:
Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
Samuel R. G. Finlayson
Affiliation:
Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire The Dartmouth Institute, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
*
Department of Orthopaedics, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756 ([email protected])
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Abstract

Objective.

To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA).

Design.

Simple decision tree model.

Setting.

Outpatient TJA clinical setting.

Participants.

Hypothetical cohort of patients with TJA.

Interventions.

A simple decision tree model compared 3 strategies in a hypothetical cohort of patients with TJA: (1) obtaining preoperative screening cultures for all patients, followed by administration of mupirocin to patients with cultures positive for Staphylococcus aureus; (2) providing empirical preoperative treatment with mupirocin for all patients without screening; and (3) providing no preoperative treatment or screening. We assessed the costs and benefits over a 1-year period. Data inputs were obtained from a literature review and from our institution's internal data. Utilities were measured in quality-adjusted life-years, and costs were measured in 2005 US dollars.

Main Outcome Measure.

Incremental cost-effectiveness ratio.

Results.

The treat-all and screen-and-treat strategies both had lower costs and greater benefits, compared with the no-treatment strategy. Sensitivity analysis revealed that this result is stable even if the cost of mupirocin was over $100 and the cost of SSI ranged between $26,000 and $250,000. Treating all patients remains the best strategy when the prevalence of S. aureus carriers and surgical site infection is varied across plausible values as well as when the prevalence of mupirocin-resistant strains is high.

Conclusions.

Empirical treatment with mupirocin ointment or use of a screen-and-treat strategy before TJA is performed is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. S. aureus decolonization with nasal mupirocin for patients undergoing TJA should be considered.

Level of Evidence.

Level II, economic and decision analysis.

Infect Control Hosp Epidemiol 2012;33(2):152-159

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 152 - 159
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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