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: Carlos Wong, In-Wa Luk, Margaret Ip, Joyce H S You
• Journal: American journal of infection control (Am J Infect Control) Vol. 42 Issue 4 Pg. 412-6 (Apr 2014) ISSN: 1527-3296 [Electronic] United States
• PMID: 24679568 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Mupirocin

Topics

• Administration, Topical
• Anti-Bacterial Agents (administration & dosage, economics)
• Cost-Benefit Analysis
• Gram-Positive Bacterial Infections (economics, prevention & control)
• Health Care Costs
• Hong Kong
• Humans
• Infection Control (economics, methods)
• Mupirocin (administration & dosage, economics)
• Peritoneal Dialysis (adverse effects)
• Peritonitis (economics, prevention & control)
• Quality of Life
• Survival Analysis