title: An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Preventive Medicine, Virgen de la Victoria University Hospital, Malaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: del Diego Salas
authors.affiliation: Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain. Electronic address: antonio.olrylabry.easp@juntadeandalucia.es.
authors.forename: A
authors.initials: A
authors.lastname: Orly de Labry Lima
authors.affiliation: Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain.
authors.forename: J
authors.initials: J
authors.lastname: Espín Balbino
authors.affiliation: Andalusian School of Public Health (EASP), Campus Universitario de Cartuja, Granada, Spain; CIBER in Epidemiology and Public Health (CIBERESP), Spain; Institute de Recherche en Santé Publique, Université de Montréal, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Bermúdez Tamayo
authors.affiliation: Department of Preventive Medicine, Virgen de la Victoria University Hospital, Malaga, Spain; Department of Preventive Medicine, University of Malaga, Malaga, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fernández-Crehuet Navajas
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus; D016712:Mupirocin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin
keywords: Cirugía torácica; Cost and cost analysis; Coste y análisis del coste; Methicillin-resistant Staphylococcus aureus; Staphylococcus aureus resistente a la meticilina; Thoracic surgery