Document Detail


Cost-effectiveness of prophylactic nasal mupirocin in patients undergoing peritoneal dialysis based on a randomized, placebo-controlled trial.
MedLine Citation:
PMID:  10381107     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The study objective was to measure the benefits of elimination of nasal carriage of Staphylococcus aureus by calcium mupirocin ointment in patients undergoing continuous ambulatory peritoneal dialysis. The design was a prospective, placebo-controlled, randomized clinical trial. The subjects were 267 patients recruited from nine renal units in Belgium, France and the UK. The main outcome measures were the rate of catheter exit site infection (ESI), rates of other infections and healthcare costs from the perspective of a hospital budget-holder. The rate of ESI caused by S. aureus was significantly reduced from one in 28.1 patient months to one in 99.3 patient months (P = 0.006) and there were also non-significant trends towards lower rates of ESI caused by any organism and peritonitis caused by S. aureus. In comparison with the placebo group, patients in the mupirocin group with ESI had lower antibiotic (P = 0.02) and hospitalization costs (P = 0.065). However, overall costs of antibiotic treatment, for all infections combined, were not significantly different (P = 0.2) and total antibiotic costs (including mupirocin) were significantly higher in the mupirocin group (P = 0.001). Mupirocin prophylaxis would have been cost-neutral if the rate of ESI increased to >75% in the placebo group, or if all healthcare costs increased by 40%, or if the cost of screening was reduced from Pound Sterling 15 to Pound Sterling 3 per patient, or if the cost of mupirocin treatment was reduced from Pound Sterling 93 to Pound Sterling 40 per patient year. In conclusion, savings in healthcare costs are unlikely to be sufficiently great to offset the cost of mupirocin and screening for nasal carriage of S. aureus. The decision about whether or not to implement mupirocin should depend on a local analysis of the value of preventing ESIs caused by S. aureus.
Authors:
P Davey; A M Craig; C Hau; M Malek
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of antimicrobial chemotherapy     Volume:  43     ISSN:  0305-7453     ISO Abbreviation:  J. Antimicrob. Chemother.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-10-26     Completed Date:  1999-10-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7513617     Medline TA:  J Antimicrob Chemother     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  105-12     Citation Subset:  IM    
Affiliation:
Medicines Monitoring Unit, University of Dundee, UK. p.davey@dundee.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Administration, Intranasal
Anti-Bacterial Agents / administration & dosage*,  economics*
Belgium
Cost-Benefit Analysis
Female
France
Great Britain
Health Care Costs
Humans
Length of Stay / economics
Male
Mass Screening / economics
Middle Aged
Mupirocin / administration & dosage*,  economics*
Peritoneal Dialysis
Staphylococcal Infections / drug therapy,  economics*,  prevention & control*
Staphylococcus aureus / drug effects
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 12650-69-0/Mupirocin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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