title: Cost-effectiveness of preoperative screening and eradication of Staphylococcus aureus carriage.
abstract: BACKGROUND
  Preoperative screening for nasal S. aureus carriage, followed by eradication treatment of identified carriers with nasal mupirocine ointment and chlorhexidine soap was highly effective in preventing deep-seated S. aureus infections. It is unknown how cost-effectiveness of this intervention is affected by suboptimal S. aureus screening. We determined cost-effectiveness of different preoperative S. aureus screening regimes.
  
  
  METHODS
  We compared different screening scenarios (ranging from treating all patients without screening to treating only identified S. aureus carriers) to the base case scenario without any screening and treatment. Screening and treatment costs as well as costs and mortality due to deep-seated S. aureus infection were derived from hospital databases and prospectively collected data, respectively.
  
  
  RESULTS
  As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs. Treating all patients without screening is most cost-beneficial, saving €7339 per life year gained, as compared to €3330 when only identified carriers are treated. In sensitivity analysis, outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment. Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening. When only identified S. aureus carriers are treated costs of screening should be less than €6.23 to become the dominant strategy.
  
  
  CONCLUSIONS
  Preoperative screening and eradication of S. aureus carriage to prevent deep-seated S. aureus infections saves both life years and medical costs at the same time, although treating all patients without screening is the dominant strategy, resulting in most health gains and largest savings.
authors.affiliation: Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands.
authors.forename: Marjan W M
authors.initials: MW
authors.lastname: Wassenberg
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D000368:Aged; D002353:Carrier State / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D010343:Patient Admission; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D011300:Preoperative Care / Q000191:economics*; D012680:Sensitivity and Specificity; D012915:Soaps; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D012915:Soaps