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The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Bruce Y. Lee ,
Ann E. Wiringa ,
Rachel R. Bailey ,
Vishal Goyal ,
Becky Tsui ,
G. Jonathan Lewis ,
Robert R. Muder  and
Lee M. Harrison
Bruce Y. Lee*
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Ann E. Wiringa
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Rachel R. Bailey
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Vishal Goyal
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Becky Tsui
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
G. Jonathan Lewis
Affiliation:
Public Health Computational and Operations Research (PHICOR), Pittsburgh, Pennsylvania Department of Biomedical Informatics, Pittsburgh, Pennsylvania Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
University of Pittsburgh, and the Division of Infectious Diseases, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania
Lee M. Harrison
Affiliation:
Infectious Disease Epidemiology Research Unit, School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
*
Public Health Computational and Operations Research (PHICOR) Group, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213 ([email protected])
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Extract

Background and Objective.

Patients undergoing orthopedic surgery are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. We sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients.

Methods.

A stochastic decision-analytic computer simulation model was used to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payer and hospital perspectives. Sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success.

Results.

Preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payer perspective even when MRSA prevalence was as low as 1%, decolonization success was as low as 25%, and decolonization costs were as high as $300 per patient. In most scenarios this strategy was economically dominant (ie, less costly and more effective than no screening). From the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios explored.

Conclusions.

Routine preoperative screening and decolonization of orthopedic surgery patients may under many circumstances save hospitals and third-party payers money while providing health benefits.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1130 - 1138
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Anderson, DJ, Sexton, DJ, Kanafani, ZA, Auten, G, Kaye, KS. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28(9):1047–1053.CrossRefGoogle ScholarPubMed
2.Walley, G, Orendi, J, Bridgman, S, Davis, B, Ahmed el, N, Maffulli, N. Methicillin resistant Staphylococcus aureus (MRSA) is not always caught on the orthopaedic ward. Acta Orthop Belg 2009;75(2):245–251.Google Scholar
3.Kato, D, Maezawa, K, Yonezawa, I, et al.Randomized prospective study on prophylactic antibiotics in clean orthopedic surgery in one ward for 1 year. J Orthop Sci 2006;11(1):20–27.CrossRefGoogle ScholarPubMed
4.Khan, OA, Weston, VC, Scammell, BE. Methicillin-resistant Staphylococcus aureus incidence and outcome in patients with neck of femur fractures. J Hosp Infect 2002;51(3):185–188.Google Scholar
5.Peacock, JE Jr, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93(4):526–532.Google Scholar
6.Wilcox, MH, Hall, J, Pike, H, et al.Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections. J Hosp Infect 2003;54(3):196–201.Google Scholar
7.Trautmann, M, Stecher, J, Hemmer, W, Luz, K, Panknin, HT. Intranasal mupirocin prophylaxis in elective surgery: a review of published studies. Chemotherapy 2008;54(1):9–16.Google Scholar
8.Hacek, DM, Paule, SM, Thomson, RB Jr, Robicsek, A, Peterson, LR. Implementation of a universal admission surveillance and decolonization program for methicillin-resistant Staphylococcus aureus (MRSA) reduces the number of MRSA and total number of S. aureus isolates reported by the clinical laboratory. J Clin Microbiol 2009;47(11):3749–3752.Google Scholar
9.Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39(6):776–782.Google Scholar
10.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al.Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197(9):1226–1234.CrossRefGoogle ScholarPubMed
11.Perl, TM. Prevention of Staphylococcus aureus infections among surgical patients: beyond traditional perioperative prophylaxis. Surgery 2003;134(suppl 5):S10–S17.CrossRefGoogle ScholarPubMed
12.Kluytmans, JA, Wertheim, HF. Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections. Infection 2005;33(1):3–8.CrossRefGoogle ScholarPubMed
13.Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999;43(6):1412–1416.Google Scholar
14.Robicsek, A, Beaumont, JL, Thomson, RB Jr, Govindarajan, G, Peterson, LR. Topical therapy for methicillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol 2009;30(7):623–632.Google Scholar
15. Garrouste-Orgeas, M, Timsit, JF, Kallel, H, et al.Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 2001;22(11):687–692.Google Scholar
16.Sankar, B, Hopgood, P, Bell, KM. The role of MRSA screening in joint-replacement surgery. Int Orthop 2005;29(3):160–163.CrossRefGoogle ScholarPubMed
17.Beigi, RH, Bunge, K, Song, Y, Lee, BY. Epidemiologic and economic effect of methicillin-resistant Staphylococcus aureus in obstetrics. Obstet Gynecol 2009;113(5):983–991.CrossRefGoogle ScholarPubMed
18.Lee, BY, Tsui, BY, Bailey, RR, et al. Should vascular surgery patients be screened preoperatively for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2009;30:1158–1165.CrossRefGoogle ScholarPubMed
19.Hacek, DM, Robb, WJ, Paule, SM, Kudrna, JC, Stamos, VP, Peterson, LR. Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res 2008;466(6):1349–1355.Google Scholar
20.Bounthavong, M, Hsu, DI, Okamoto, MP. Cost-effectiveness analysis of linezolid vs. vancomycin in treating methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections using a decision analytic model. Int J Clin Pract 2009;63(3):376–386.Google Scholar
21.CPT Code/Relative Value Search. American Medical Association Web site. https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp. Accessed April 17, 2009.Google Scholar
22.Levit, K, Stranges, E, Ryan, K, Elbmauser, A. HCUP Facts and Figures, 2006: Statistics on Hospital-based Care in the United States. Rockville, MD: Agency for Healthcare Research and Quality, 2008.Google Scholar
23.Gold, MR, Franks, P, McCoy, KI, Fryback, DG. Toward consistency in cost-utility analyses: using national measures to create condition-specific values. Med Care 1998;36(6):778–792.Google Scholar
24.Tengs, TO, Wallace, A. One thousand health-related quality-of-life estimates. Med Care 2000;38(6):583–637.Google Scholar
25.Sackett, DL, Torrance, GW. The utility of different health states as perceived by the general public. J Chronic Dis 1978;31(11):697–704.Google Scholar
26.Selai, C, Rosser, R. Eliciting EuroQol descriptive data and utility scale values from inpatients: a feasibility study. Pharmacoeconomics 1995;8(2):147–158.CrossRefGoogle ScholarPubMed
27.Reyes, J, Hidalgo, M, Diaz, L, et al.Characterization of macrolide resistance in gram-positive cocci from Colombian hospitals: a countrywide surveillance. Int J Infect Dis 2007;11(4):329–336.Google Scholar
28.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344(1):11–16.CrossRefGoogle ScholarPubMed
29.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39(7):971–979.CrossRefGoogle ScholarPubMed
30.Pujol, M, Pena, C, Pallares, R. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996;100(5):509–516.Google Scholar
31.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36(3):281–285.Google Scholar
32.Corbella, X, Dominguez, MA, Pujol, M. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16(5):351–357.CrossRefGoogle ScholarPubMed
33.Lee, YL, Cesario, T, Gupta, G. Surveillance of colonization and infection with Staphylococcus aureus susceptible or resistant to methicillin in a community skilled-nursing facility. Am J Infect Control 1997;25(4):312–321.Google Scholar
34.Nather, A, Bee, CS, Huak, CY. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications 2008;22(2):77–82.Google Scholar
35.Roche, SJ, Fitzgerald, D, O'Rourke, A, McCabe, JP. Methicillin-resistant Staphylococcus aureus in an Irish orthopaedic centre: a five-year analysis. J Bone Joint Surg Br 2006;88(6):807–811.CrossRefGoogle Scholar
36.Kilgus, DJ, Howe, DJ, Strang, A. Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 2002;404:116–124.CrossRefGoogle Scholar
37.Tai, CC, Nirvani, AA, Holmes, A, Hughes, SP. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. Int Orthop 2004;28(1):32–35.Google Scholar
38.Sankar, B, Hopgood, P, Bell, KM. The role of MRSA screening in joint-replacement surgery. Int Orthop 2005;29:160–163.CrossRefGoogle ScholarPubMed
39.Wenisch, C, Laferl, H, Szell, M, et al.A holistic approach to MRSA eradication in critically ill patients with MRSA pneumonia. Infection 2006;34(3):148–154.CrossRefGoogle ScholarPubMed
40.Drinka, P, Faulks, JT, Gauerke, C, Goodman, B, Stemper, M, Reed, K. Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home. Arch Intern Med 2001;161(19):2371–2377.Google Scholar
41.DeRyke, CA, Lodise, TP Jr, Rybak, MJ, McKinnon, PS. Epidemiology, treatment and outcomes of nosocomial bacteremic Staphylococcus aureuspneumonia. Chest 2005;128(3):1414–1422.Google Scholar
42.Fleisch, F, Zbinden, R, Vanoli, R, Ruef, C. Epidemie spread of a single clone of methicillin-resistant Staphylococcus aureus among injection drug users in Zurich, Switzerland. Clin Infect Dis 2001;32(4):581–586.CrossRefGoogle Scholar
43.Athanassa, Z, Siempos, II, Falagas, ME. Impact of methicillin resistance on mortality in Staphylococcus aureus VAP: a systemic review. Eur Respir J 2008;31(3):625–632.CrossRefGoogle Scholar
44.Wunderink, RG, Relio, J, Cammarata, SK, Croos-Dabrera, RV, Kollef, MH. Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Chest 2003;124(5):1789–1797.Google Scholar
45.Jeffres, MN, Isakow, W, Doherty, JA, et al.Predictors of mortality for methicillin-resistant Staphylococcus aureus health-care-associated pneumonia. Chest 2006;130(4):947–955.CrossRefGoogle ScholarPubMed
46.Hageman, JC, Uyeki, TM, Francis, JS, et al.Severe community-acquired pneumonia due to Staphylococcus aureus, 2003-04 influenza season. Emerg Infect Dis 2006;12(6):894–899.CrossRefGoogle ScholarPubMed
47.Kollef, KE, Reichley, RM, Micek, ST, Kollef, MH. The modified APACHE II score outperforms Curb65 pneumonia severity score as a predictor of 30-day mortality in patients with methicillin-resistant Staphylococcus aureus pneumonia. Chest 2008;133(2):363–369.CrossRefGoogle ScholarPubMed
48.Wilmoth, J, Shkolnikov, V. The human mortality database. The human mortality database Web site, http://www.mortality.org. Accessed April 12, 2009.Google Scholar
49.Gold, M, Siegel, JE, Russell, LB, Weinstein, MC. Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press, 1996.CrossRefGoogle ScholarPubMed
50.Sloan, F. Valuing Health Care: Costs, Benefits, and Effectiveness of Pharmaceuticals and Medical Technologies. New York, NY: Cambridge University Press, 1995.CrossRefGoogle Scholar
51.Braithwaite, RS, Meitzer, DO, King, JT Jr, Leslie, D, Roberts, MS. What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 2008;46(4):349–356.CrossRefGoogle Scholar
52.Rabinovich, M, Greenberg, D, Shemer, J. Threshold values for cost-effectiveness ratio and public funding of medical technologies [in Hebrew]. Harefuah 2007;146(6):453-458, 500.Google ScholarPubMed
53.Laupacis, A, Feeny, D, Detsky, AS, Tugwell, PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992;146(4):473–481.Google ScholarPubMed
54.Shorr, AF, Tabak, YP, Kilian, AD, Gupta, V, Liu, LZ, Kollef, MH. Healthcare-associated bloodstream infection: a distinct entity? Insights from a large U.S. database. Crit Care Med 2006;34(10):2588–2595.Google Scholar
55.Graves, N, Halton, K, Lairson, D. Economics and preventing hospital-acquired infection: broadening the perspective. Infect Control Hosp Epidemiol 2007;28(2):178–184.CrossRefGoogle ScholarPubMed
56.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10(4):561–566.CrossRefGoogle ScholarPubMed
57.Clinical laboratory fee schedule. Centers for Medicare and Medicaid Services Web site. http://www.cms.gov/ClinicalLabFeeSched/02_clinlab.asp#TopOfPage. Published 2010. Accessed April 2, 2010.Google Scholar
58.McConeghy, KW, Mikolich, DJ, LaPlante, KL. Agents for the decolonization of methicillin-resistant Staphylococcus aureus. Pharmacotherapy 2009;29(3):263–280.CrossRefGoogle ScholarPubMed
59.Red Book 2009. Montvale, NJ: Thompson Healthcare, 2009.Google Scholar
60.Cookson, BD. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41(1):11–18.CrossRefGoogle ScholarPubMed
61.Ammerlaan, HS, Kluytmans, JA, Wertheim, HF, Nouwen, JL, Bonten, MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48(7):922–930.Google Scholar
62.Lee, BY, Bailey, RR, Smith, KJ, et al.Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 2010;31:598–606.Google Scholar