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Routine pre-cesarean Staphylococcus aureus screening and decolonization: a cost-effectiveness analysis.

Bruce Y Lee¹, Ann E Wiringa, Elizabeth A Mitgang

¹Public Health Computational and Operations Research, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. BYL1@pitt.edu

The American Journal of Managed Care

|November 23, 2011

Summary

Pre-cesarean screening for Staphylococcus aureus (S aureus) carriage is generally not cost-effective. This finding holds true even with high cesarean delivery rates, especially when using advanced PCR methods.

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Area of Science:

Medical Economics
Infectious Disease Prevention
Health Services Research

Background:

* Staphylococcus aureus (S aureus) carriage in pregnant women poses a risk for surgical site infections after cesarean delivery.
* Screening and decolonization strategies aim to mitigate these risks.
* The economic value of such interventions requires careful evaluation.

Purpose of the Study:

* To estimate the economic value of screening pregnant women for S aureus carriage before cesarean delivery.
* To assess the cost-effectiveness of routine S aureus screening and decolonization.

Main Methods:

* A computer simulation model was employed to assess cost-effectiveness from a third-party payer perspective.
* Sensitivity analyses examined variables including S aureus colonization prevalence, decolonization success rates, and laboratory techniques (agar vs. PCR).

Main Results:

* Pre-cesarean screening and decolonization were cost-effective only under specific conditions: using agar for both screening and wound cultures with high decolonization success (≥50%) and colonization prevalence (≥40%), or higher decolonization success (≥75%) with lower prevalence (≥20%).
* PCR-based methods were never found to be cost-effective.
* The number needed to screen varied widely (21 to 2294) based on prevalence, lab techniques, and decolonization success.

Conclusions:

* Presurgical screening for S aureus and decolonization of carriers is unlikely to be cost-effective for pregnant women undergoing cesarean delivery under current epidemiological conditions.
* Laboratory technique choice significantly impacts the economic viability of screening interventions.