Comparative costs of ertapenem and cefotetan as prophylaxis for elective colorectal surgery.
OBJECTIVE
The costs of treating surgical site infections can be considerable. There is a cost associated with the prophylactic use of antibiotics; however, the use of prophylactic agents may reduce infection rates and lengths of stay, thus offsetting the overall treatment cost and potentially generating cost savings to hospitals. This project was intended to determine the potential cost impact of using ertapenem 1 g vs. cefotetan 2 g as prophylaxis for elective colorectal surgery.


METHODS
Cost analysis using efficacy data from the PREVENT clinical trial and drug acquisition and total hospital costs in 2005 dollars from Premier's Perspective Comparative Database in patients > or = 18 year of age, evaluable at four weeks after elective surgery of the colon or rectum and prophylactic treatment with ertapenem (n = 338) or cefotetan (n = 334). The primary outcome measures were the rate of prophylactic drug failure and the difference between the ertapenem and cefotetan groups in costs related to and total hospital stay. Prophylactic failure was defined as a surgical site infection, unexplained antibiotic use, or anastomotic leak.


RESULTS
Prophylactic failure occurred in 28.1% of the patients receiving ertapenem and 42.8% of those receiving cefotetan (p < 0.05). The most common prophylactic failure was surgical site infection: 18.3% for ertapenem, 31.1% for cefotetan, difference (95% confidence interval) -13.0% (-19.5, -6.5%) (p < 0.05). The mean +/- standard deviation length of stay for all patients, including prophylactic successes and failures, was 7.6 +/- 6.6 days for ertapenem and 8.7 +/- 9.5 days for cefotetan. The mean per-patient cost of prophylactic drugs and hospital room and board was $15,245 with ertapenem and $17,428 cefotetan, a net difference of -$2,181.


CONCLUSIONS
Ertapenem used in prophylaxis for elective colorectal operations results in a lower rate of surgical site infection and a shorter average length of stay than cefotetan. The calculated net difference in prophylactic antibiotic drug and hospital costs represents a saving of $2,181 per patient with ertapenem relative to cefotetan.
Wilson
Samuel E
SE
Department of Surgery, University of California, Irvine, Orange, California, USA.
Turpin
Robin S
RS
Kumar
Ritesh N
RN
Itani
Kamal M F
KM
Jensen
Erin H
EH
Pellissier
James M
JM
Abramson
Murray A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000706:statistics & numerical data; D015313:Cefotetan / Q000191:economics / Q000627:therapeutic use*; D003107:Colorectal Surgery / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D000077727:Ertapenem; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*; D017211:Treatment Failure; D016896:Treatment Outcome; D047090:beta-Lactams / Q000191:economics / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D015313:Cefotetan; D000077727:Ertapenem