An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery
| Autor: | J. del Diego Salas, C. Bermúdez Tamayo, J. Fernández-Crehuet Navajas, A. Orly de Labry Lima, J. Espín Balbino |
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| Rok vydání: | 2015 |
| Předmět: |
Methicillin-Resistant Staphylococcus aureus
medicine.medical_specialty Cost-Benefit Analysis Psychological intervention Mupirocin 030501 epidemiology 03 medical and health sciences Indirect costs chemistry.chemical_compound 0302 clinical medicine Internal medicine medicine Humans Surgical Wound Infection 030212 general & internal medicine Protocol (science) business.industry Health Policy Incidence (epidemiology) Cardiovascular Surgical Procedures General Medicine Cost-effectiveness analysis Staphylococcal Infections Surgery Cardiac surgery Anti-Bacterial Agents chemistry Economic evaluation 0305 other medical science business |
| Zdroj: | Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial. 31(1) |
| ISSN: | 1887-1364 |
| Popis: | Objective To conduct a cost-effectiveness analysis that compares two prophylactic protocols for treating post-surgical infections in cardiac surgery. Methods A cost effectiveness analysis was done by using a decision tree to compare two protocols for prophylaxis of post-surgical infections (Protocol A: Those patient with positive test to methicillin-resistant Staphylococcus aureus (MRSA) colonization received muripocin (twice a day during a two-week period), with no follow-up verification. Those who tested negative did not receive the prophylaxis treatment; Protocol B: all patients received the mupirocin treatment). The number of post-surgical infections averted was the measure of effectiveness from the health system's perspective, 30 days following the surgery. The incidence of infections and complications was obtained from two cohorts of patients who underwent cardiac surgery Hospital. The times for applying the two protocols were validated by experts. They cost were calculated from the hospital's analytical accounting management system and Pharmaceutical Service. Only direct costs were taken into account, no discount rates were applied. Incremental cost-effectiveness ratio (ICER) was calculated. A probabilistic sensitivity analysis was performed. Results A total of 1118 patients were included (721 in Protocol A and 397 in Protocol B). No statistically significant differences were found in age, sex, diabetes, exitus or length of hospital stay between the two protocols. In the control group the rate of infection was 15.3%, compared with 11.3% in the intervention group. Protocol B proves to be more effective and at a lower cost, yielding an ICER of €32,506. Conclusion Universal mupirocin prophylaxis against surgical site infections (SSI) in cardiac surgery as a dominant strategy, because it shows a lower incidence of infections and cost savings, versus the strategy to treat selectively patients according to their test results prior screening. |
| Databáze: | OpenAIRE |
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