Preoperative Use of Mupirocin for the Prevention of Healthcare-Associated Staphylococcus aureus Infections: A Cost-Effectiveness Analysis

Abstract

Objective.Staphylococcus aureus is the most common cause of healthcare-associated infections. Intranasal mupirocin treatment probably decreases S. aureus infections among colonized surgical patients. Using cost-effectiveness analysis, we evaluated the cost-effectiveness of preoperative use of mupirocin for the prevention of healthcare-associated S. aureus infections.Methods.Three strategies were compared: (1) screen with nasal culture and give treatment to carriers, (2) give treatment to all patients without screening, and (3) neither screen nor treat. A societal perspective was taken. Adverse outcomes included bloodstream infection, pneumonia, surgical site infection, death due to underlying illness or infection, readmission, and the need for home health care. Data inputs were obtained from an extensive MEDLINE review and from publicly available government data sources. The following base-case data inputs (and ranges) for sensitivity analysis were used: rate of S. aureus carriage, 23.1% (19%-55%); efficacy ofmupirocin treatment, 51% (8%-75%); mupirocin treatment cost, $48.36 ($24.18-$57.74); and hospital costs of bloodstream infection, $25,128 ($6,194-$40,211), pneumonia, $18,366 ($5,574-$28,952), and surgical site infection $16,256 ($5,119-$22,553). Widespread use ofmupirocin has been associated with high levels of mupirocin resistance; therefore, a broad range of estimates for efficacy was tested in the sensitivity analysis.Patients.The target population included patients undergoing nonemergent surgery requiring postoperative hospitalization.Results.Both the screen-and-treat and treat-all strategies were cost saving, saving $102 per patient screened and $88 per patient treated, respectively. In 1-way sensitivity analyses, the model was robust with respect to all data inputs except for the efficacy ofmupirocin treatment. If the efficacy is less than 16.1%, then the screen-and-treat strategy is cost incurring. A treat-all strategy was more cost saving if the rate of S. aureus carriage was greater than 42.7%, the mupirocin cost was less than $29.87, or nursing compensation was greater than $64.21 per hour.Conclusion.Administration of mupirocin before surgery is cost saving, primarily because healthcare-associated infections are very expensive. The level of mupirocin efficacy is critical to the cost-effectiveness of this intervention.