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Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation
OBJECTIVE: Infection following cochlear implantation is medically and economically devastating. The cost-effectiveness (CE) of colonization screening and decolonization for infection prophylaxis in cochlear implantation has not been examined. STUDY DESIGN: An analytic observational study of data col...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684140/ https://www.ncbi.nlm.nih.gov/pubmed/31428733 http://dx.doi.org/10.1177/2473974X19866391 |
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author | Kirchner, Gregory J. Ghazaryan, Hovhannes Lieber, Alexander M. Sunkerneni, Anisha Reddy McKinnon, Brian J. |
author_facet | Kirchner, Gregory J. Ghazaryan, Hovhannes Lieber, Alexander M. Sunkerneni, Anisha Reddy McKinnon, Brian J. |
author_sort | Kirchner, Gregory J. |
collection | PubMed |
description | OBJECTIVE: Infection following cochlear implantation is medically and economically devastating. The cost-effectiveness (CE) of colonization screening and decolonization for infection prophylaxis in cochlear implantation has not been examined. STUDY DESIGN: An analytic observational study of data collected from purchasing records and the literature. METHODS: Costs of Staphylococcus aureus colonization screening and decolonization were acquired from purchasing records and the literature. Infection rates after cochlear implantation and average total costs for evaluation and treatment were obtained from a review of the literature. A break-even analysis was performed to determine the required absolute risk reduction (ARR) in infection rate to make colonization screening or decolonization CE. RESULTS: Nasal screening ($144.07) is CE if the initial infection rate (1.7%) had an ARR of 0.60%. Decolonization with 2% intranasal mupirocin ointment ($5.09) was CE (ARR, 0.02%). A combined decolonization technique (2% intranasal mupirocin ointment, chlorhexidine wipes, chlorhexidine shower, and prophylactic vancomycin: $37.57) was CE (ARR, 0.16%). Varying infection rate as high as 15% demonstrated that CE did not change by maintaining an ARR of 0.16%. CE of the most expensive decolonization protocol was enhanced as the cost of infection treatment increased, with an ARR of 0.03% at $125,000. CONCLUSIONS: Prophylactic S aureus decolonization techniques can be CE for preventing infection following cochlear implantation. Decolonization with mupirocin is economically justified if it prevents at least 1 infection out of 5000 implants. S aureus colonization screening needed high reductions in infection rate to be CE. |
format | Online Article Text |
id | pubmed-6684140 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-66841402019-08-19 Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation Kirchner, Gregory J. Ghazaryan, Hovhannes Lieber, Alexander M. Sunkerneni, Anisha Reddy McKinnon, Brian J. OTO Open Original Research OBJECTIVE: Infection following cochlear implantation is medically and economically devastating. The cost-effectiveness (CE) of colonization screening and decolonization for infection prophylaxis in cochlear implantation has not been examined. STUDY DESIGN: An analytic observational study of data collected from purchasing records and the literature. METHODS: Costs of Staphylococcus aureus colonization screening and decolonization were acquired from purchasing records and the literature. Infection rates after cochlear implantation and average total costs for evaluation and treatment were obtained from a review of the literature. A break-even analysis was performed to determine the required absolute risk reduction (ARR) in infection rate to make colonization screening or decolonization CE. RESULTS: Nasal screening ($144.07) is CE if the initial infection rate (1.7%) had an ARR of 0.60%. Decolonization with 2% intranasal mupirocin ointment ($5.09) was CE (ARR, 0.02%). A combined decolonization technique (2% intranasal mupirocin ointment, chlorhexidine wipes, chlorhexidine shower, and prophylactic vancomycin: $37.57) was CE (ARR, 0.16%). Varying infection rate as high as 15% demonstrated that CE did not change by maintaining an ARR of 0.16%. CE of the most expensive decolonization protocol was enhanced as the cost of infection treatment increased, with an ARR of 0.03% at $125,000. CONCLUSIONS: Prophylactic S aureus decolonization techniques can be CE for preventing infection following cochlear implantation. Decolonization with mupirocin is economically justified if it prevents at least 1 infection out of 5000 implants. S aureus colonization screening needed high reductions in infection rate to be CE. SAGE Publications 2019-08-05 /pmc/articles/PMC6684140/ /pubmed/31428733 http://dx.doi.org/10.1177/2473974X19866391 Text en © The Authors 2019 http://www.creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Kirchner, Gregory J. Ghazaryan, Hovhannes Lieber, Alexander M. Sunkerneni, Anisha Reddy McKinnon, Brian J. Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title | Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title_full | Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title_fullStr | Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title_full_unstemmed | Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title_short | Cost-effectiveness of Preoperative Staphylococcus aureus Screening and Decolonization in Cochlear Implantation |
title_sort | cost-effectiveness of preoperative staphylococcus aureus screening and decolonization in cochlear implantation |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684140/ https://www.ncbi.nlm.nih.gov/pubmed/31428733 http://dx.doi.org/10.1177/2473974X19866391 |
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