VandenBergh M F, Kluytmans J A, van Hout B A, Maat A P, Seerden R J, McDonnel J, Verbrugh H A
Department of Clinical Microbiology, University Hospital, Rotterdam, The Netherlands.
Infect Control Hosp Epidemiol. 1996 Dec;17(12):786-92. doi: 10.1086/647237.
To assess the cost-effectiveness of perioperative intranasal application of mupirocin calcium ointment in cardiothoracic surgery.
Cost-effectiveness analysis based on results of an intervention study with historical controls.
University Hospital Rotterdam, a tertiary referral center for cardiac and pulmonary surgery.
Consecutive patients undergoing cardiothoracic surgery between August 1, 1989, and February 1, 1991 (control group, n = 928), and between March 1, 1991, and August 1, 1992 (intervention group, n = 868).
Perioperative nasal application of mupirocin calcium ointment started on the day before surgery, continued for 5 days, twice daily.
Postoperative costs were increased significantly in patients with a surgical-site infection (SSI), compared with uninfected patients (P < .001). Mean SSI-attributable costs were estimated at $16,878 (95% confidence interval, $15,575-$18,181). The incidence of SSIs was 7.3% in the control group and 2.8% in the intervention group, mupirocin effectiveness being 62%. The costs of mupirocin were $11 per patient. Thus, the savings per SSI prevented were $16,633. To validate this comparative estimate of SSI-attributable costs, a noncomparative analysis of the postoperative length of stay (POLS) was performed, according to the Appropriateness Evaluation Protocol. Approximately 50% of the comparative SSI-attributable POLS were judged SSI-attributable in the noncomparative analysis. Sensitivity analyses, testing for the robustness of our conclusions, indicated that the presented model is rather insensitive to variations in the incidence of SSIs and for the effectiveness and costs of mupirocin. SSI-attributable costs were shown to be the only variable with substantial effect on the cost-effectiveness ratio. Perioperative mupirocin would result in net costs instead of savings only if SSI-attributable costs were less than $245.
SSIs in patients undergoing cardiothoracic surgery are associated with a substantial increase in postoperative costs. Provided that perioperative mupirocin reduces the SSI rate, this measure will be highly cost-effective in most centers providing cardiothoracic surgical services.
评估心胸外科手术围手术期鼻内应用莫匹罗星钙软膏的成本效益。
基于一项有历史对照的干预性研究结果进行成本效益分析。
鹿特丹大学医院，一家心脏和肺部手术的三级转诊中心。
1989年8月1日至1991年2月1日期间连续接受心胸外科手术的患者（对照组，n = 928），以及1991年3月1日至1992年8月1日期间的患者（干预组，n = 868）。
围手术期于手术前一天开始鼻内应用莫匹罗星钙软膏，持续5天，每日两次。
与未发生手术部位感染（SSI）的患者相比，发生SSI的患者术后成本显著增加（P <.001）。SSI所致的平均成本估计为16,878美元（95%置信区间，15,575 - 18,181美元）。对照组的SSI发生率为7.3%，干预组为2.8%，莫匹罗星的有效性为62%。莫匹罗星的成本为每位患者11美元。因此，每预防一例SSI节省的费用为16,633美元。为验证这种对SSI所致成本的比较性估计，根据适当性评估方案对术后住院时间（POLS）进行了非比较性分析。在非比较性分析中，约50%的比较性SSI所致POLS被判定为SSI所致。敏感性分析检验了我们结论的稳健性，结果表明所提出的模型对SSI发生率的变化以及莫匹罗星的有效性和成本变化相当不敏感。结果显示，SSI所致成本是对成本效益比有实质性影响的唯一变量。仅当SSI所致成本低于245美元时，围手术期应用莫匹罗星才会导致净成本而非节省费用。
心胸外科手术患者发生的SSI与术后成本大幅增加相关。倘若围手术期应用莫匹罗星可降低SSI发生率，那么在大多数提供心胸外科手术服务的中心，这一措施将具有很高的成本效益。
