Routine Pre-cesarean Staphylococcus aureus Screening and Decolonization: A Cost-Effectiveness Analysis

Details

• Alternative Title:
  Am J Manag Care
• Personal Author:
  Lee, Bruce Y. ; Wiringa, Ann E. ; Mitgang, Elizabeth A. ; McGlone, Sarah M. ; Afriyie, Abena N. ; Song, Yeohan ; Beigi, Richard H.
• Description:
  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.
  
  
• Subjects:
  Cesarean Section Computer Simulation Cost-Benefit Analysis Female Humans Mass Screening Perioperative Care Pregnancy Pregnancy Complications, Infectious Staphylococcal Infections Surgical Wound Infection United States

  More +
• Source:
  Am J Manag Care. 17(10):693-700
• Pubmed ID:
  22106462
• Pubmed Central ID:
  PMC3836821
• Document Type:
  Journal Article
• Funding:
  5R01LM009132-02/LM/NLM NIH HHSUnited States/ ; 5P01HK00086-02/HK/PHITPO CDC HHSUnited States/ ; 1U54GM088491-0109/GM/NIGMS NIH HHSUnited States/ ; P01 HK000086/HK/PHITPO CDC HHSUnited States/ ; U54 GM088491/GM/NIGMS NIH HHSUnited States/ ; R01 LM009132/LM/NLM NIH HHSUnited States/
• Volume:
  17
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:b06ed25d55dc627f127d84ed879c9067a37edcb9541d65372a2e287485c79050
• Download URL:
  https://stacks.cdc.gov/view/cdc/33643/cdc_33643_DS1.pdf
• File Type:
  [PDF - 755.50 KB ]