Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization

Area of Science:

• Infectious Disease Epidemiology
• Health Economics
• Surgical Safety

Background:

• Surgical site infections (SSIs) due to Staphylococcus aureus (S. aureus) increase patient morbidity and healthcare expenditures.
• Preoperative decolonization strategies aim to reduce S. aureus colonization and subsequent SSIs.

Purpose of the Study:

• To evaluate the impact of a preoperative S. aureus decolonization bundle on SSIs, health-care-associated costs (HCACs), and mortality.
• To compare the effectiveness and cost-efficiency of three preoperative strategies: standard of care (SOC), "test-and-treat," and "treat-all."

Main Methods:

• A decision analytic model was developed using parameters from a randomized controlled trial on decolonization bundle efficacy.
• The model population included US adults undergoing elective surgery.
• Three strategies were evaluated: SOC (disinfectant soap showers), "test-and-treat" (decolonization bundle if S. aureus positive), and "treat-all" (decolonization bundle for all patients).

Main Results:

• The "treat-all" strategy resulted in the fewest SSIs and lowest HCACs, followed by the "test-and-treat" strategy.
• Compared to SOC, "treat-all" saved an average of $217 per operation, and "test-and-treat" saved $123.
• The average savings per SSI prevented were $21,929 for "treat-all" and $15,166 for "test-and-treat."

Conclusions:

• The "treat-all" decolonization strategy is predicted to be the most effective and cost-saving for preventing SSIs.
• Further studies are necessary to assess potential risks, such as increased mupirocin resistance and medication adverse effects, associated with the "treat-all" approach.