562. Comparative Cost Analysis of Two Strategies for Preoperative Use of Mupirocin in Prosthetic Joint Replacement Patients
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Surgical site infections (SSI) following prosthetic joint (PJ) replacement can have devastating and costly consequences for patients. Staphylococcus aureus (SA) is a common cause of these infections; the source is often the patient’s own flora. There is evidence that preoperative decolonization of SA-colonized patients with mupirocin reduces post-operative SA infection rates after clean orthopaedic procedures. We performed a cost analysis comparing 2 strategies for preoperative mupirocin use in patients undergoing PJ replacement.
Methods: We performed a cost and sensitivity analysis for 2 strategies. In the “treat all” strategy, all patients receive 5 days of intranasal mupirocin ointment before surgery. In the “Screen and Treat” strategy, preoperative nasal cultures are obtained and only SA culture positive patients receive mupirocin. We adopted a societal perspective with a 1-year time horizon. Adverse outcomes included excess hospitalization attributable to SSI. We used DHMC base-case data inputs (and ranges from the available literature) for sensitivity analysis: rate of SA colonization, 27% (19%-55%); rate of SSI, 1.1 % (0.5%-3%); efficacy of mupirocin treatment, 61% (46%-76%); mupirocin treatment cost, $6 for a 5 day course ($4.97-10.97); and Nasal bacterial culture screening test cost, $11.62 ($5.81-$23.24). Estimated direct costs of SSI, $17,700 ($5,000-$22,500) came from published literature.
Results: Both the “screen and treat”, and “treat all” strategies were cost-saving compared with no preoperative mupirocin use. At current colonization rates, sensitivity analysis favored the “treat all” strategy unless the cost of screening fell to $2 below the cost of the 5 day course of mupirocin. “Screen and treat” was cost saving over the status quo at $11.62 as long as the efficacy of mupirocin was greater than 7%.
Conclusions: Using conservative assumptions, administering preoperative mupirocin to all PJ replacement patients at DHMC would prevent 6.7 SSI and save $112,797 each year. Feasibility of the “treat all” strategy, along with the safety of mupirocin for short-term use makes this approach appealing.
Marian Bihrle, BA, Dartmouth Hitchcock Medical Center, Lebanon, NH, Kathryn Kirkland, MD, FSHEA, Dartmouth-Hitchcock Medical Center, Lebanon, NH and  M. M. Bihrle, None..
K. B. Kirkland, None.