van Enckevort PJ, Zwaveling JH, Botterma JT, Maring JK, Klompmaker IJ, Slooff MJ, Tenvergert EM; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 111.
Departments of Surgery, Internal Medicine, and Office for Medical Technology Assessment, University Hospital, Groningen, the Netherlands.
OBJECTIVE: The cost effectiveness of selective decontamination of the digestive tract (SD) to prevent infections in patients undergoing liver transplantation is still debated. Therefore we performed an economic evaluation in which the cost effectiveness of SD in liver transplantation was assessed. METHODS: An economic evaluation was added to a randomized, placebo-controlled, double-blind trial. Patients of two university hospitals in the Netherlands were randomized to receive either SD or placebo, from the moment they were accepted for transplantation. In the economic evaluation, the effect parameter was the mean number of postoperative infections. Since the mean number of postoperative infections did not differ between groups, a cost minimization analysis was performed. Besides costs related to SD (medication, cultures) other pre- and postoperative direct medical costs (e.g. hospitalization, outpatient visits, services) were determined, till 30 days after transplantation. True resource costs were assessed against 1997 prices. Costs were compared with a Mann-Whitney U test (alpha=0.05). All analyses were by per protocol analysis; patients who stopped using SD/placebo or died preoperatively were excluded. Furthermore, in assessing the postoperative outcomes, patients who died during or shortly after transplantation were excluded. RESULTS: Preoperative costs were based on 58 patients (SD:29, placebo:29). Postoperative costs and infections were based on 55 patients (SD;26, placebo: 29). Costs of SD medication and related cultures were $3,300 per SD patient. Other direct medical costs (SD:$28,900, placebo: $29,200) and the mean number of infections (SD:1.77, placebo:1.93) did not significantly differ between groups. CONCLUSIONS: SD leads to additional costs of medication and cultures, whereas no savings in other costs and no improvement in infections are realized. Consequently, SD may be considered as a non-efficient approach in liver transplantation, and if no longer used, considerable savings may be realized. DISCUSSION: The study design was mainly chosen on behalf of the clinical part of the trial. Therefore, SD was given to the patients in an earlier stage than in normal practice and analyses were by per protocol. The consequences of a more pragmatic design and an intention-to-treat analysis for the economic evaluation will be discussed; additional analyses showed no changes in the main conclusions regarding cost effectiveness.
Publication Types:
Keywords:
- Cost-Benefit Analysis
- Costs and Cost Analysis
- Decontamination
- Double-Blind Method
- Health Resources
- Hospitalization
- Humans
- Kidney Transplantation
- Liver Transplantation
- Netherlands
- Placebos
- Postoperative Complications
- economics
- surgery
- transplantation
- hsrmtgs
Other ID:
UI: 102194031
From Meeting Abstracts