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Cost-effectiveness of preoperative screening and eradication of Staphylococcus aureus carriage.

Wassenberg MW, de Wit GA, Bonten MJ - PLoS ONE (2011)

Bottom Line: We determined cost-effectiveness of different preoperative S. aureus screening regimes.As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs.Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands.

ABSTRACT

Background: Preoperative screening for nasal S. aureus carriage, followed by eradication treatment of identified carriers with nasal mupirocine ointment and chlorhexidine soap was highly effective in preventing deep-seated S. aureus infections. It is unknown how cost-effectiveness of this intervention is affected by suboptimal S. aureus screening. We determined cost-effectiveness of different preoperative S. aureus screening regimes.

Methods: We compared different screening scenarios (ranging from treating all patients without screening to treating only identified S. aureus carriers) to the base case scenario without any screening and treatment. Screening and treatment costs as well as costs and mortality due to deep-seated S. aureus infection were derived from hospital databases and prospectively collected data, respectively.

Results: As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs. Treating all patients without screening is most cost-beneficial, saving €7339 per life year gained, as compared to €3330 when only identified carriers are treated. In sensitivity analysis, outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment. Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening. When only identified S. aureus carriers are treated costs of screening should be less than €6.23 to become the dominant strategy.

Conclusions: Preoperative screening and eradication of S. aureus carriage to prevent deep-seated S. aureus infections saves both life years and medical costs at the same time, although treating all patients without screening is the dominant strategy, resulting in most health gains and largest savings.

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Related in: MedlinePlus

Effect of suboptimal adherence to preoperative S. aureus screening and treatment effectiveness on cost per life year gained (discounted) per 1000 patients for different screening scenarios.Scenario 1 is treatment of S. aureus carriers identified by screening; scenario 2 is treatment of S. aureus carriers identified by screening plus treatment of all patients that were not screened. In scenario 1 the life years gained and costs increase, or decrease, at a constant rate resulting in an invariable cost per life years gained. Note the negative costs on the y-axis representing cost-savings.
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pone-0014815-g003: Effect of suboptimal adherence to preoperative S. aureus screening and treatment effectiveness on cost per life year gained (discounted) per 1000 patients for different screening scenarios.Scenario 1 is treatment of S. aureus carriers identified by screening; scenario 2 is treatment of S. aureus carriers identified by screening plus treatment of all patients that were not screened. In scenario 1 the life years gained and costs increase, or decrease, at a constant rate resulting in an invariable cost per life years gained. Note the negative costs on the y-axis representing cost-savings.

Mentions: We have assumed that the relative risk of deep-seated S. aureus infections after eradication treatment was 0.21 compared to placebo. However, if the effect of the intervention is lower, health outcomes and cost savings are less (Figure 3), and when the relative risk with eradication is less than, respectively, 0.53 and 0.62 for scenario 1 and 2, the intervention is no longer cost-saving.


Cost-effectiveness of preoperative screening and eradication of Staphylococcus aureus carriage.

Wassenberg MW, de Wit GA, Bonten MJ - PLoS ONE (2011)

Effect of suboptimal adherence to preoperative S. aureus screening and treatment effectiveness on cost per life year gained (discounted) per 1000 patients for different screening scenarios.Scenario 1 is treatment of S. aureus carriers identified by screening; scenario 2 is treatment of S. aureus carriers identified by screening plus treatment of all patients that were not screened. In scenario 1 the life years gained and costs increase, or decrease, at a constant rate resulting in an invariable cost per life years gained. Note the negative costs on the y-axis representing cost-savings.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3102653&req=5

pone-0014815-g003: Effect of suboptimal adherence to preoperative S. aureus screening and treatment effectiveness on cost per life year gained (discounted) per 1000 patients for different screening scenarios.Scenario 1 is treatment of S. aureus carriers identified by screening; scenario 2 is treatment of S. aureus carriers identified by screening plus treatment of all patients that were not screened. In scenario 1 the life years gained and costs increase, or decrease, at a constant rate resulting in an invariable cost per life years gained. Note the negative costs on the y-axis representing cost-savings.
Mentions: We have assumed that the relative risk of deep-seated S. aureus infections after eradication treatment was 0.21 compared to placebo. However, if the effect of the intervention is lower, health outcomes and cost savings are less (Figure 3), and when the relative risk with eradication is less than, respectively, 0.53 and 0.62 for scenario 1 and 2, the intervention is no longer cost-saving.

Bottom Line: We determined cost-effectiveness of different preoperative S. aureus screening regimes.As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs.Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands.

ABSTRACT

Background: Preoperative screening for nasal S. aureus carriage, followed by eradication treatment of identified carriers with nasal mupirocine ointment and chlorhexidine soap was highly effective in preventing deep-seated S. aureus infections. It is unknown how cost-effectiveness of this intervention is affected by suboptimal S. aureus screening. We determined cost-effectiveness of different preoperative S. aureus screening regimes.

Methods: We compared different screening scenarios (ranging from treating all patients without screening to treating only identified S. aureus carriers) to the base case scenario without any screening and treatment. Screening and treatment costs as well as costs and mortality due to deep-seated S. aureus infection were derived from hospital databases and prospectively collected data, respectively.

Results: As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs. Treating all patients without screening is most cost-beneficial, saving €7339 per life year gained, as compared to €3330 when only identified carriers are treated. In sensitivity analysis, outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment. Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening. When only identified S. aureus carriers are treated costs of screening should be less than €6.23 to become the dominant strategy.

Conclusions: Preoperative screening and eradication of S. aureus carriage to prevent deep-seated S. aureus infections saves both life years and medical costs at the same time, although treating all patients without screening is the dominant strategy, resulting in most health gains and largest savings.

Show MeSH
Related in: MedlinePlus