title: Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis.
abstract: BACKGROUND
  Gram-positive bacteria are the major causative pathogens of peritonitis and exit site infection in patients undergoing peritoneal dialysis (PD). We investigated the cost-effectiveness of regular application of mupirocin at the exit site in PD recipients from the perspective of health care providers in Hong Kong.
  
  
  METHODS
  A decision tree was designed to simulate outcomes of incident PD patients with and without regular application of mupirocin over a 1-year period. Outcome measures included total direct medical costs, quality-adjusted life-years (QALYs) gained, and gram-positive infection-related mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables.
  
  
  RESULTS
  In a base case analysis, the mupirocin group had a higher expected QALY value (0.6496 vs 0.6456), a lower infection-related mortality rate (0.18% vs 1.64%), and a lower total cost per patient (US $258 vs $1661) compared with the control group. The rate of gram-positive peritonitis without mupirocin and the risk of gram-positive peritonitis with mupirocin were influential factors. In 10,000 Monte Carlo simulations, the mupirocin group had significantly lower associated costs, higher QALYs, and a lower mortality rate 99.9% of the time.
  
  
  CONCLUSIONS
  Topical mupirocin appears to be a cost-effective preventive measure against gram-positive infection in incident patients undergoing PD. The cost-effectiveness of mupirocin is affected by the level of infection risk reduction and subject to resistance against mupirocin.
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Carlos
authors.initials: C
authors.lastname: Wong
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: In-Wa
authors.initials: IW
authors.lastname: Luk
authors.affiliation: Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Margaret
authors.initials: M
authors.lastname: Ip
authors.affiliation: School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong. Electronic address: joyceyou@cuhk.edu.hk.
authors.forename: Joyce H S
authors.initials: JH
authors.lastname: You
mesh_terms: D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D016908:Gram-Positive Bacterial Infections / Q000191:economics / Q000517:prevention & control*; D017048:Health Care Costs; D006723:Hong Kong; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D016712:Mupirocin / Q000008:administration & dosage* / Q000191:economics; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010538:Peritonitis / Q000191:economics / Q000517:prevention & control*; D011788:Quality of Life; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin
keywords: Direct medical costs; Exit site infection; Mupirocin; Peritonitis; Quality-adjusted life-years