Journal of Antimicrobial Chemotherapy (1999) 43, 105-112
© 1999 The British Society for Antimicrobial Chemotherapy
Cost-effectiveness of prophylactic nasal mupirocin in patients undergoing peritoneal dialysis based on a randomized, placebo-controlled trial
a Medicines Monitoring Unit, University of Dundee b Pharmacoeconomics Research Centre, University of St Andrews c Department of Epidemiology and Public Health, University of Dundee, UK
The study objective was to measure the benefits of elimination of nasal carriage of Staphylococcus auus by calcium mupirocin ointment in patients undergoing continuous ambulatory peritoneal dialysis. The design was a prospective, placebo-controlled, randomized clinical trial. The subjects were 267 patients recruited from nine renal units in Belgium, France and the UK. The main outcome measures were the rate of catheter exit site infection (ESI), rates of other infections and healthcare costs from the perspective of a hospital budget-holder. The rate of ESI caused by S. aureus was significantly reduced from one in 28.1 patient months to one in 99.3 patient months (P = 0.006) and there were also non-significant trends towards lower rates of ESI caused by any organism and peritonitis caused bS. aureus. In comparison with the placebo group, patients in the mupirocin group with ESI had lower antibiotic (P = 0.02) and hospitalization costs (P = 0.065). However, overall costs of antibiotic treatment, for all infections combined, were not significantly different (P = 0.2) and total antibiotic costs (including mupirocin) were significantly higher in the mupirocin group (P = 0.001). Mupirocin prophylaxis would have been cost-neutral if the rate of ESI increased to >75% in the placebo group, or if all healthcare costs increased by 40%, or if the cost of screening was reduced from £15 to £3 per patient, or if the cost of mupirocin treatment was reduced from £93 to £40 per patient year. In conclusion, savings in healthcare costs are unlikely to be sufficiently great to offset the cost of mupirocin and screening for nasal carriage of S. aureus. The decision about whether or not to implement mupirocin should depend on a local analysis of the value of preventing ESIs caused by S. aureus.
* Corresponding address: Medicines Monitoring Unit, Department of Clinical Pharmacology, Ninewells Hospital, Dundee DD1 9SY, UK. E-mail: p.davey{at}dundee.ac.uk
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