Department of Orthopaedics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
Infect Control Hosp Epidemiol. 2012 Feb;33(2):152-9. doi: 10.1086/663704.
To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA).
Simple decision tree model.
Outpatient TJA clinical setting.
Hypothetical cohort of patients with TJA.
A simple decision tree model compared 3 strategies in a hypothetical cohort of patients with TJA: (1) obtaining preoperative screening cultures for all patients, followed by administration of mupirocin to patients with cultures positive for Staphylococcus aureus; (2) providing empirical preoperative treatment with mupirocin for all patients without screening; and (3) providing no preoperative treatment or screening. We assessed the costs and benefits over a 1-year period. Data inputs were obtained from a literature review and from our institution's internal data. Utilities were measured in quality-adjusted life-years, and costs were measured in 2005 US dollars.
Incremental cost-effectiveness ratio.
The treat-all and screen-and-treat strategies both had lower costs and greater benefits, compared with the no-treatment strategy. Sensitivity analysis revealed that this result is stable even if the cost of mupirocin was over $100 and the cost of SSI ranged between $26,000 and $250,000. Treating all patients remains the best strategy when the prevalence of S. aureus carriers and surgical site infection is varied across plausible values as well as when the prevalence of mupirocin-resistant strains is high.
Empirical treatment with mupirocin ointment or use of a screen-and-treat strategy before TJA is performed is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. S. aureus decolonization with nasal mupirocin for patients undergoing TJA should be considered.
Level II, economic and decision analysis.
进行成本效益分析，以评估全关节置换术（TJA）患者术前使用莫匹罗星的效果。
简单决策树模型。
门诊 TJA 临床环境。
TJA 患者的假设队列。
在 TJA 患者的假设队列中，一个简单的决策树模型比较了 3 种策略：（1）对所有患者进行术前筛查培养，然后对金黄色葡萄球菌培养阳性的患者使用莫匹罗星；（2）对所有患者进行莫匹罗星经验性术前治疗而不进行筛查；（3）不进行术前治疗或筛查。我们在 1 年内评估成本和收益。数据输入来自文献回顾和我们机构的内部数据。效用以质量调整生命年来衡量，成本以 2005 年美元来衡量。
增量成本效益比。
与无治疗策略相比，全治疗和筛查-治疗策略的成本更低，获益更大。敏感性分析表明，即使莫匹罗星的成本超过 100 美元，手术部位感染的成本在 26,000 美元至 250,000 美元之间，这一结果也是稳定的。当金黄色葡萄球菌携带者和手术部位感染的患病率在各种可能的数值范围内变化时，以及当莫匹罗星耐药株的患病率较高时，治疗所有患者仍然是最佳策略。
在进行 TJA 之前，使用莫匹罗星软膏进行经验性治疗或采用筛查-治疗策略是一种简单、安全且具有成本效益的干预措施，可以降低 SSI 的风险。对于接受 TJA 的患者，应考虑使用鼻用莫匹罗星进行金黄色葡萄球菌去定植。
II 级，经济和决策分析。
