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

Courville, Xan F.; Tomek, Ivan M.; Kirkland, Kathryn B.; Birhle, Marian; Kantor, Stephen; Finlayson, Samuel R.G.

doi:10.1086/663704

Cited by 93 publications

(92 citation statements)

References 35 publications

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“…Two studies showed that decolonizing all patients instead of only colonized patients was the most cost-beneficial, in which USD 9969 was saved per life year gained when all patients were treated [10], and there was USD 330 saved per qualityadjusted life year (QALY) for THA and USD 438 saved per QALY for TKA when all patients were decolonized [55]. Slover et al [48] determined cost savings by calculating the reduction in revision rate that was needed to make up for the cost of implementing a S. aureus screening and decolonization protocol; there needed to be a 35% reduction in the revision rate for patients having TKA and Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies (Table 3) examined the cost of implementing a S. aureus screening and decolonization protocol [10,19,22,34,36,42,43,48,52,55]. The method of evaluating costs differed among studies, because four of the studies were based on economic models [10,34,48,55], whereas ITT = intention to treat; MSSA = methicillin-sensitive S. aureus; MRSA = methicillin-resistant S. aureus; RCT = randomized controlled trial; RR = relative risk; SSI = surgical site infection.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

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Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

Chen

Wessel

Rao

2013

Clinical Orthopaedics &Amp; Related Research

172

100

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Section: Resultsmentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

Chen

Wessel

Rao

2013

Clinical Orthopaedics &Amp; Related Research

172

100

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“…This includes applying 2% mupirocin in nares two times daily for 5 days. Using intranasal mupirocin preoperatively has been shown to have significant cost savings by reducing SSI [19]. Additionally, daily chlorhexidine showers for 5 days before surgery as well as daily laundering of clothing, towels, and bed linens are included in the protocol.…”

Section: Diabetesmentioning

confidence: 99%

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Sveom¹,

Otteman²,

Garvin³

2017

Curr Rev Musculoskelet Med

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Purpose of review Total joint arthroplasty (TJA) has had an increased demand over the recent years. It is a successful procedure, and there are relatively few complications, but there is a high overall cost. There is a push to increase the quality of care, lessen complications, and decrease cost by reducing readmissions. This article will discuss the risk factors that can contribute to the complication and readmission rates following TJA. Recent findings Several risk factors have been found to contribute to the complication and readmission rates following a TJA. It is important to understand these risk factors and mitigate them as much as possible in order to optimize the patient experience. There are risk factors that cannot be modified, and the treatment team as well as the patient should be made aware of these and account for them when making the decision whether to undergo elective primary TJA or not. In general, an increased number of risk factors is associated with increased complications and increased readmission rates. At our institution, we have used this knowledge to improve our outcomes and decrease costs. Summary It is important to be mindful of risk factors for poor outcomes prior to performing TJA. This allows for the optimization of patients prior to undergoing surgery. This can lead to improved outcomes at a lower cost.

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“…[53][54][55][56][57] However, two studies were conducted by the same author group: one was a cost-effectiveness evaluation and the second was a systematic review with a cost-effectiveness evaluation. 53 As the same decision problem and decision model were used in both these publications, only the more recent and updated article was included.…”

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

“…A study by Courville et al 56 examined the cost-effectiveness of preoperative nasal mupirocin treatment in patients with total hip or knee arthroplasty. Three strategies were compared in a decision tree model: preoperative screening for all patients and treatment with mupirocin for patients testing positive for S. aureus; preoperative administration of mupirocin to all patients and no screening; and neither preoperative treatment nor screening.…”

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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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

Abstract: Level II, economic and decision analysis.

Cited by 93 publications

References 35 publications

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

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