title: Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients.
abstract: 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.
authors.affiliation: Office of Medical Technology Assessment, University Hospital Groningen, The Netherlands. pevane@hetnet.nl
authors.forename: P J
authors.initials: PJ
authors.lastname: van Enckevort
authors.forename: J H
authors.initials: JH
authors.lastname: Zwaveling
authors.forename: J T
authors.initials: JT
authors.lastname: Bottema
authors.forename: J K
authors.initials: JK
authors.lastname: Maring
authors.forename: I J
authors.initials: IJ
authors.lastname: Klompmaker
authors.forename: M J
authors.initials: MJ
authors.lastname: Slooff
authors.forename: E M
authors.initials: EM
authors.lastname: TenVergert
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents