加拿大艾伯塔省髋关节和膝关节置换术前使用莫匹罗星和葡萄糖酸洗必泰进行去定植与标准治疗的成本效果分析。
A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for decolonization prior to hip and knee arthroplasty in Alberta, Canada compared to standard of care.
机构信息
1Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada.
2Departments of Medicine; Microbiology, Immunology and Infectious Diseases; Pathology and Laboratory Medicine, O'Brien Institute for Public Health; Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada.
出版信息
Antimicrob Resist Infect Control. 2019 Jul 11;8:113. doi: 10.1186/s13756-019-0568-5. eCollection 2019.
BACKGROUND
While decolonization of reduces surgical site infection (SSI) rates following hip and knee arthroplasty, its cost-effectiveness is uncertain. We sought to examine the cost-effectiveness of a decolonization protocol for prior to hip and knee replacement in Alberta compared to standard care - no decolonization.
METHODS
Decision analytic models and a probabilistic sensitivity analysis were used for a cost-effectiveness analysis, with the effectiveness of decolonization based on a large published pre- and post- intervention trial. The primary outcomes of the models were infections prevented and health care costs. We modelled the cost-effectiveness of decolonization in a hypothetical cohort of adult patients undergoing hip and knee replacement in Alberta, Canada. Information on the incidence of complex surgical site infections (SSIs), as well as the cost of care for patients with and without SSIs was taken from a provincial infection control database, and health administrative data.
RESULTS
Use of the decolonization bundle was cost saving compared to usual care ($153/person), and resulted in 16 complex SSIs annually as opposed to 32 (with approximately 8000 hip or knee arthroplasties performed). The probabilistic sensitivity analysis demonstrated that the majority (84%) of the time the decolonization bundle was cost saving. The model was robust to one-way sensitivity analyses conducted within plausible ranges. There were small upfront costs associated with using a decolonization protocol, however, this model demonstrated cost savings over one year. In a Markov model that considered the impact of a decolonization bundle over a lifetime as it pertained to the need for subsequent joint replacements and patient quality of life, the bundle still resulted in cost savings ($161/person).
CONCLUSIONS
Decolonization for prior to hip and knee replacements resulted in cost savings and fewer SSIs, and should be considered prior to these procedures.
背景
虽然去殖民化降低了髋膝关节置换术后的手术部位感染（SSI）率，但它的成本效益尚不确定。我们旨在研究与标准护理（不进行去殖民化）相比，艾伯塔省髋膝关节置换术前对金黄色葡萄球菌进行去殖民化的成本效益，方法：使用决策分析模型和概率敏感性分析进行成本效益分析，去殖民化的有效性基于一项大型发表的干预前后试验。模型的主要结果是预防感染和医疗保健成本。我们在加拿大艾伯塔省接受髋膝关节置换术的假设成年患者队列中对去殖民化的成本效益进行建模。关于复杂手术部位感染（SSI）发生率的信息，以及患有和不患有 SSI 的患者的护理成本信息均来自省级感染控制数据库和健康管理数据。
结果
与常规护理相比，使用去殖民化方案可节省 153 加元/人，每年可预防 16 例复杂的金黄色葡萄球菌 SSI，而不是 32 例（每年进行约 8000 例髋或膝关节置换术）。概率敏感性分析表明，在大多数情况下（84％），去殖民化方案具有成本效益。该模型对在合理范围内进行的单向敏感性分析具有稳健性。使用去殖民化方案会产生前期成本，但是该模型在一年内可节省成本。在考虑去殖民化方案对后续关节置换和患者生活质量的影响的终生马尔可夫模型中，该方案仍可节省成本（161 加元/人）。
结论
在髋膝关节置换术前对金黄色葡萄球菌进行去殖民化可节省成本并减少 SSI，因此应在进行这些手术之前考虑。
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