Noskin Gary A, Rubin Robert J, Schentag Jerome J, Kluytmans Jan, Hedblom Edwin C, Jacobson Cassie, Smulders Maartje, Gemmen Eric, Bharmal Murtuza
Northwestern University, the Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Infect Control Hosp Epidemiol. 2008 Jan;29(1):16-24. doi: 10.1086/524327.
To evaluate the economic impact of performing rapid testing for Staphylococcus aureus colonization before admission for all inpatients who are scheduled to undergo elective surgery and providing subsequent decolonization therapy for those patients found to be colonized with S. aureus.
A budget impact model that used probabilistic sensitivity analysis to account for the uncertainties in the input variables was developed. Primary input variables included the marginal effect of S. aureus infection on patient outcomes among patients who underwent elective surgery, patient demographic characteristics, the prevalence of nasal carriage of S. aureus, the sensitivity and specificity of the rapid diagnostic test for S. aureus colonization, the efficacy of decolonization therapy for nasal carriage of S. aureus, and cost data. Data sources for the input variables included the 2003 Nationwide Inpatient Sample data and the published literature.
In 2003, there were an estimated 7,181,484 patients admitted to US hospitals for elective surgery. Our analysis indicated preadmission testing and subsequent decolonization therapy for patients colonized with S. aureus would have produced a mean annual cost savings to US hospitals of $231,538,400 (95% confidence interval [CI], -$300 million to $1.3 billion). The mean annual number of hospital-days that could have been eliminated was estimated at 364,919 days (95% CI, 67,893-926,983 days), and a mean of 935 in-hospital deaths (95% CI, 88-3,691) could have been avoided per year. Sensitivity analysis indicated a 64.5% probability that there would be cost savings to US hospitals as a result of preadmission testing and subsequent decolonization therapy.
The addition of preadmission testing and decolonization therapy to standard care would result in significant cost savings, even after accounting for variations in the model input values.
评估对所有计划接受择期手术的住院患者入院前进行金黄色葡萄球菌定植快速检测，并对检测发现定植有金黄色葡萄球菌的患者进行后续去定植治疗的经济影响。
开发了一个预算影响模型，该模型使用概率敏感性分析来考虑输入变量中的不确定性。主要输入变量包括金黄色葡萄球菌感染对接受择期手术患者的患者结局的边际效应、患者人口统计学特征、金黄色葡萄球菌鼻腔携带率、金黄色葡萄球菌定植快速诊断试验的敏感性和特异性、金黄色葡萄球菌鼻腔携带去定植治疗的疗效以及成本数据。输入变量的数据来源包括2003年全国住院患者样本数据和已发表的文献。
2003年，估计有7181484名患者入住美国医院接受择期手术。我们的分析表明，对定植有金黄色葡萄球菌的患者进行入院前检测和后续去定植治疗，每年可为美国医院节省平均成本231538400美元（95%置信区间[CI]，-3亿美元至13亿美元）。估计每年可消除的平均住院天数为364919天（95%CI，67893 - 926983天），每年平均可避免935例住院死亡（95%CI，88 - 3691例）。敏感性分析表明，入院前检测和后续去定植治疗使美国医院节省成本的概率为64.5%。
即使考虑模型输入值的变化，在标准护理中增加入院前检测和去定植治疗也将显著节省成本。
