• Rachel A Elliott, Helen L A Weatherly, Neil S Hawkins, Gillian Cranny, Duncan Chambers, Lindsey Myers, Alison Eastwood, and Mark J Sculpher.
• Division of Social Research in Medicines and Health, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK. rachel.elliott@nottingham.ac.uk
• Eur J Health Econ. 2010 Feb 1;11(1):57-66.

AimSurgical site infection is commonly caused by Staphylococcus aureus. The multiresistant strains (MRSA) are resistant to most antibiotic prophylaxis regimens. Our aim was to explore whether there is a threshold of MRSA prevalence at which switching to routine glycopeptide-based antibiotic prophylaxis becomes cost-effective.MethodsAn indicative model was designed to explore the cost-effectiveness of vancomycin, cephalosporin or a combination, in patients undergoing primary hip arthroplasty.ResultsIf the MRSA infection rate is equal to or above 0.25% and the rate of other infections with cephalosporin prophylaxis is equal to or above 0.2%, use of the combination antibiotic prophylaxis is optimal.DiscussionModelling the cost-effectiveness of interventions for MRSA prevention is complex due to uncertainty around resistance and effectiveness of glycopeptides.ConclusionsThe indicative model provides a framework for evaluation. More work is needed to understand the impact of antibiotic resistance over time in these currently effective antibiotics.

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