CLINICAL AND ECONOMIC-EFFECTS OF MUPIROCIN CALCIUM ON PREVENTING STAPHYLOCOCCUS-AUREUS INFECTION IN HEMODIALYSIS-PATIENTS - A DECISION-ANALYSIS

This study was performed to determine the clinical and economic conseq uences of alternative strategies of preventing Staphylococcus aureus i nfection in chronic hemodialysis patients by use of intranasal mupiroc in calcium to clear nasal carriage of S aureus. Decision analysis eval uated clinical outcomes and cost-effectiveness of three likely managem ent strategies to address S aureus nasal carriage and prevent subseque nt infection in chronic ambulatory hemodialysis patients: (1) screen f or S aureus nasal carriage every 3 months and treat those with a posit ive test result with mupirocin calcium; (2) treat all patients weekly with mupirocin calcium; or (3) no prevention strategy, treat infection only, Rates of nasal carriage of S aureus, S aureus infection rates, proportion of infections attributable to nasal carriage, efficacy of m upirocin, natural history of infection, and patient management strateg ies were derived from the published literature and supplemented by a p anel of experts, Actual payments for medical services were obtained fr om Medicare parts A and B, Incremental cost-effectiveness was calculat ed from the perspective of Medicare and subjected to sensitivity analy ses. Assuming that 75% of S aureus infections are attributable to nasa l carriage in hemodialysis patients, eliminating nasal carriage of S a ureus with mupirocin calcium (with or without screening) markedly redu ces the number of infections (45% to 55%) and also reduces health care expenditures relative to treating infections when they occur, Annual savings to Medicare are $784,000 to $1,117,000 per 1,000 hemodialysis patients, depending on the prevention strategy, Preventing S aureus in fection by eradicating nasal carriage in chronic hemodialysis patients reduces morbidity while simultaneously reducing medical care costs, T he decision to eliminate nasal carriage on a regular basis or use a sc reening test to guide antibiotic therapy is dependent on the tradeoff between improved short-term clinical and cost benefits and the potenti al for bacterial resistance that may arise from widespread use of mupi rocin calcium. (C) 1996 by the National Kidney Foundation, Inc.