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Budget Impact Analysis of Rapid Screening for Staphylococcus aureus Colonization Among Patients Undergoing Elective Surgery in US Hospitals

Published online by Cambridge University Press:  02 January 2015

Gary A. Noskin ,
Robert J. Rubin ,
Jerome J. Schentag ,
Jan Kluytmans ,
Edwin C. Hedblom ,
Cassie Jacobson ,
Maartje Smulders ,
Eric Gemmen  and
Murtuza Bharmal
Gary A. Noskin*
Affiliation:
Northwestern University, the Feinberg School of Medicine, and Northwestern Memorial Hospital, Chicago, Illinois
Robert J. Rubin
Affiliation:
Georgetown University, Washington, DC
Jerome J. Schentag
Affiliation:
University of Buffalo, NewYork
Jan Kluytmans
Affiliation:
Amphia Hospital, Breda Medical Center of the Free University (VUmc Medical), Amsterdam, The Netherlands
Edwin C. Hedblom
Affiliation:
3M Medical Diagnostics, St. Paul, Minnesota
Cassie Jacobson
Affiliation:
3M Medical Diagnostics, St. Paul, Minnesota
Maartje Smulders
Affiliation:
Quintiles Strategic Research and Safety, Falls Church, Virginia
Eric Gemmen
Affiliation:
Quintiles Strategic Research and Safety, Falls Church, Virginia
Murtuza Bharmal
Affiliation:
Quintiles Strategic Research and Safety, Falls Church, Virginia
*
Northwestern Memorial Hospital, 676 N. St. Clair St., Ste. 700, Chicago, IL 60611 (gnoskin@northwestern.edu)
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Abstract

Objective.

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.

Methods.

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.

Results.

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.

Conclusion.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 16 - 24
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Mainous, AG 3rd, Hueston, WJ, Everett, CJ, Diaz, VA. Nasal carriage of Staphylococcus aureus and methicillin-resistant S. aureus in the United States, 2001-2002. Ann Farn Med 2006;4:132–137.CrossRefGoogle ScholarPubMed
2.Wertheim, HF, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751–762.CrossRefGoogle ScholarPubMed
3.Noskin, GA, Rubin, RJ, Schentag, JJ, et al.The burden of Staphylococcus aureus infections on hospitals in the United States: an analysis of the 2000 and 2001 Nationwide Inpatient Sample Database. Archives of Internal Medicine 2005;165:1756–1761.CrossRefGoogle ScholarPubMed
4.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R; National Nosocomial Infections Surveillance System. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42:389–391.CrossRefGoogle ScholarPubMed
5.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31:481–498.CrossRefGoogle Scholar
6.Perl, TM. Prevention of Staphylococcus aureus infections among surgical patients: beyond traditional perioperative prophylaxis. Surgery 2003;134(5 suppl):S10–17.CrossRefGoogle ScholarPubMed
7.Laupland, KB, Conly, JM. Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: an evidence-based review. Clin Infect Dis 2003;37:933–8.CrossRefGoogle ScholarPubMed
8.Perl, TM, Cullen, JJ, Wenzel, RP, et al.Intranasal mupirocin to prevent postoperative S. aureus infections. N Engl J Med 2002;346:1871–1877.CrossRefGoogle Scholar
9.Cimochowski, GE, Harostock, MD, Brown, R, Bernardi, M, Alonzo, N, Coyle, K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 2001;71:1572–1579.CrossRefGoogle Scholar
10.Kluytmans, JA, Wertheim, HF. Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections. Infection 2005;33:3–8.CrossRefGoogle ScholarPubMed
11.Cookson, BD. The emergence of mupirocin resistance: a challenge to infection control and antibiotic prescribing practice. J Antimicrob Chemother 1998;41:11–18.CrossRefGoogle ScholarPubMed
12.Loveday, HP, Pellowe, CM, Jones, SR, Pratt, RJ. A systematic review of the evidence for interventions for the prevention and control of methicillin-resistant Staphylococcus aureus (1996-2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 2006;63(suppl 1):S45–70.CrossRefGoogle Scholar
13.Kluytmans, JA, van Belkum, A, Verbugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed
14.Nicholson, MR, Huesman, LA. Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients. Am J Infect Control 2006;34:44–48.CrossRefGoogle ScholarPubMed
15.Yano, M, Doki, Y, Inoue, M, Tsujinaka, T, Shiozaki, H, Monden, M. Preoperative intranasal mupirocin ointment significantly reduces postoperative infection with Staphylococcus aureus in patients undergoing upper gastrointestinal surgery. Surg Today 2000;30:16–21.CrossRefGoogle ScholarPubMed
16.Kluytmans, JA, Mouton, JW, VandenBergh, MF, et al. Reduction of surgical-site infections in cardiothoracic surgery by elimination of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 1996;17:780–785.CrossRefGoogle ScholarPubMed
17.Shrestha, NK, Shermock, KM, Gordon, SM, et al.Predictive value and cost-effectiveness analysis of a rapid polymerase chain reaction for preoperative detection of nasal carriage of Staphylococcus aureus. Infect Control Hosp Epidemiol 2003;24:327–333.CrossRefGoogle ScholarPubMed
18.Gift, TL, Pate, MS, Hook, EW 3rd, Kassler, WJ. The rapid test paradox: when fewer cases detected lead to more cases treated: a decision analysis of tests for Chlamydia trachomatis. Sex Transm Dis 1999;26:232–240.CrossRefGoogle ScholarPubMed
19.Bootsma, MC, Diekmann, O, Bonten, MJ. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 2006;103:5620–5625.CrossRefGoogle ScholarPubMed
20.Fang, H, Hedin, G. Rapid screening and identification of methicillin-resistant Staphylococcus aureus from clinical samples by selective-broth and real-time PCR assay. J Clin Microbiol 2003;41:2894–2899.CrossRefGoogle ScholarPubMed
21.Kluytmans, JA, Manders, MJ, van Bommel, E, Verbrugh, H. Elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients. Infect Control Hosp Epidemiol 1996;17:793–797.CrossRefGoogle ScholarPubMed
22.Bloom, BS, Fendrick, AM, Chernew, ME, Patel, P. Clinical and economic effects of mupirocin calcium on preventing Staphylococcus aureus infection in hemodialysis patients: a decision analysis. Am J Kidney Dis 1996;27:687–694.CrossRefGoogle ScholarPubMed
23.Cooper, BS, Stone, SP, Kibbler, CC, et al.Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modeling. Health Technol Assess 2003;7:1–194.CrossRefGoogle Scholar
24.Agency for Healthcare Research and Quality. Overview of the Nationwide Inpatient Sample (NIS). Available at: http://www.hcup-us.ahrq.gov/ni-soverview.jsp. Accessed August 2006.Google Scholar
25.Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, et al.Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006;193:172–179.CrossRefGoogle ScholarPubMed
26.Perl, TM, Golub, JE. New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage. Ann Phar-macother 1998;32:S7–16.CrossRefGoogle ScholarPubMed
27.US Department of Labor, Bureau of Labor Statistics. November 2004 occupational employment and wage estimates: national cross-industry estimates. Available at: http://http://www.bls.gov/oes/2004/november/oes_nat.htm. Accessed November 19, 2007.Google Scholar
28.Prospective Payment System Payment Impact File, Medicare, financial year 2004. Available at: http://www.cms.hhs.gov/AcuteInpatientPPS/02_stepspps.asp#TopOfPage. Accessed November 20, 2006.Google Scholar
29.Porter, R, Subramani, K, Thomas, AN, Chadwick, P. Nasal carriage of Staphylococcus aureus on admission to intensive care: incidence and prognostic significance. Intensive Care Med 2003;29:655–658.CrossRefGoogle ScholarPubMed
30.Casewell, MW, Hill, RLR. Elimination of nasal carriage of Staphylococcus aureus with mupirocin (‘pseudomonic acid’)—a controlled trial. J An-timicrob Chemother 1986;17:365–372.CrossRefGoogle ScholarPubMed
31.McAnally, TP, Lewis, MR, Brown, DR. Effect of rifampin and bacitracin on nasal carriers of Staphylococcus aureus. Antimicrob Agents Chemother 1984;25:422–426.CrossRefGoogle ScholarPubMed
32.Yu, VL, Goetz, A, Wagener, M, et al.Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986;315:91–96.CrossRefGoogle ScholarPubMed
33.Wertheim, HF, Vos, MC, Ott, A, et al.Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study. Ann Intern Med 2004;140:419–425.CrossRefGoogle ScholarPubMed
34.US Census Bureau. Consumer price indexes for all urban consumers (CPI-U) for selected items and groups: 1990 to 2004 (table 708). Statistical Abstract of the United States: 2006. Available at: http://www.census.gov/compendia/statab/2006/prices/prices.pdf). Accessed November 19, 2007.Google Scholar
35.Average Wholesale Price Red Book Annual. 108th ed. Montvale, NJ: Thompson PDR; 2004.Google Scholar
36.Briggs, AH. Handling uncertainty in cost-effectiveness models. Phar-macoeconomics 2000;17:479–500.Google ScholarPubMed
37.Briggs, AH, O'Brien, BJ, Blackhouse, G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Ann Rev Pub Health 2002;23:377–401.CrossRefGoogle ScholarPubMed
38.Nathwani, D. Impact of methicillin-resistant Staphylococcus aureus infections on key health economic outcomes: does reducing the length of hospital stay matter? J Antimicrob Chemother 2003;51(suppl 2):ii37–44.CrossRefGoogle ScholarPubMed
39.Yoon, HJ, Choi, JY, Kim, CO, Kim, JM, Song, YG. A comparison of clinical features and mortality among methicillin-resistant and methicillin-sen-sitive strains of Staphylococcus aureus endocarditis. Yonsei Med J 2005;46:496–502.CrossRefGoogle ScholarPubMed
40.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
41.Martin, JN, Perdreau-Remington, F, Kartalija, M, et al.A randomized clinical trial of mupirocin in the eradication of Staphylococcus aureus nasal carriage in human immunodeficiency virus disease. J Infect Dis 1999;180:896–899.CrossRefGoogle ScholarPubMed
42.Fernandez, C, Gaspar, C, Torrellas, A, Vindel, A, Saez-Nieto, JA, Cruzet, F, Aguilar, L. A double-blind, randomized, placebo-controlled clinical trial to evaluate the safety and efficacy of mupirocin calcium ointment for eliminating nasal carriage of Staphylococcus aureus among hospital personnel. J Antimicrob Chemother 1995;35:399–408.CrossRefGoogle ScholarPubMed