Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients.
OBJECTIVE
To assess the cost effectiveness of selective decontamination of the digestive tract (SDD) in liver transplant patients.


METHODS
Randomised, placebo-controlled, double-blind trial with an integrated economic evaluation.


METHODS
Two university hospitals in The Netherlands. Cost effectiveness was assessed from a societal perspective.


METHODS
58 patients who underwent liver transplantation and received SDD (n = 29) or placebo (n = 29) pre- and postoperatively.


METHODS
SDD medication and placebo.


METHODS
Infection episodes, days of infection, costs of SDD and routine cultures, mean other direct medical costs per patient and additional costs of severe infection.


RESULTS
Costs of SDD medicine and routine cultures were on average 3,100 US dollars ($US; 1997 values) per patient who underwent SDD. Both preoperatively and postoperatively, costs other than SDD and cultures did not significantly differ between the SDD and the placebo groups (preoperative, $US2,370 vs $US2,590; postoperative, $US25,455 vs $US24,915). Additional postoperative costs of severe infections were $US250 per day per patient. There were no significant differences in the mean number of infection episodes between groups.


CONCLUSIONS
SDD leads to the additional costs of SDD medication and routine cultures, whereas no savings in other costs and no improvement in infection episodes are realised. Consequently, SDD may be considered as a nonefficient approach in patients undergoing liver transplantation. The additional costs of severe infection are considerable.
van Enckevort
P J
PJ
Office of Medical Technology Assessment, University Hospital Groningen, The Netherlands. pevane@hetnet.nl
Zwaveling
J H
JH
Bottema
J T
JT
Maring
J K
JK
Klompmaker
I J
IJ
Slooff
M J
MJ
TenVergert
E M
EM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004064:Digestive System / Q000382:microbiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007902:Length of Stay; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D009426:Netherlands; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control
D000900:Anti-Bacterial Agents