cost-effectiveness of preoperative screening and eradication of staphylococcus aureus carriage成本效益的术前检查和消除金黄色葡萄球菌马车.pdf

Cost-Effectiveness of Preoperative Screening and Eradication of Staphylococcus aureus Carriage Marjan W. M. Wassenberg1,2, G. Ardine de Wit3,4, Marc J. M. Bonten1,3* 1 Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands, 2 Department of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, the Netherlands, 3 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands, 4 National Institute of Public Health and the Environment, Bilthoven, 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 J7339 per life year gained, as compared to J3330 when only identified carriers are treated. In sensitivity analysis, outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment. Redu