Routine pre-cesarean Staphylococcus aureus screening and decolonization: a cost-effectiveness analysis.

TitleRoutine pre-cesarean Staphylococcus aureus screening and decolonization: a cost-effectiveness analysis.
Publication TypeJournal Article
Year of Publication2011
AuthorsLee BY, Wiringa AE, Mitgang EA, McGlone SM, Afriyie AN, Song Y, Beigi RH
JournalAm J Manag Care
Volume17
Issue10
Pagination693-700
Date Published2011 Oct
ISSN1936-2692
KeywordsCesarean Section, Computer Simulation, Cost-Benefit Analysis, Female, Humans, Mass Screening, Perioperative Care, Pregnancy, Pregnancy Complications, Infectious, Staphylococcal Infections, Surgical Wound Infection, United States
Abstract

OBJECTIVES: To estimate the economic value of screening pregnant women for Staphylococcus aureus carriage before cesarean delivery.STUDY DESIGN: Computer simulation model.METHODS: We used computer simulation to assess the cost-effectiveness, from the third-party payer perspective, of routine screening for S aureus (and subsequent decolonization of carriers) before planned cesarean delivery. Sensitivity analyses explored the effects of varying S aureus colonization prevalence, decolonization treatment success rate (for the extent of the puerperal period), and the laboratory technique (agar culture vs polymerase chain reaction [PCR]) utilized for screening and pathogen identification from wound isolates.RESULTS: Pre-cesarean screening and decolonization were only cost-effective when agar was used for both screening and wound cultures when the probability of decolonization success was ≥ 50% and colonization prevalence was ≥ 40%, or decolonization was ≥ 75% successful and colonization prevalence was ≥ 20%. The intervention was never cost-effective using PCR-based laboratory methods. The cost of agar versus PCR and their respective sensitivities and specificities, as well as the probability of successful decolonization, were important drivers of the economic and health impacts of preoperative screening and decolonization of pregnant women. The number needed to screen ranged from 21 to 2294, depending on colonization prevalence, laboratory techniques used, and the probability of successful decolonization.CONCLUSIONS: Despite high rates of cesarean delivery, presurgical screening of pregnant women for S aureus and decolonization of carriers is unlikely to be cost-effective under prevailing epidemiologic circumstances.

Alternate JournalAm J Manag Care
PubMed ID22106462
PubMed Central IDPMC3836821
Grant List1U54GM088491-0109 / GM / NIGMS NIH HHS / United States
5P01HK00086-02 / HK / PHITPO CDC HHS / United States
5R01LM009132-02 / LM / NLM NIH HHS / United States
R01 LM009132 / LM / NLM NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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