Single-dose versus multiple-dose antibiotic prophylaxis for the surgical treatment of closed fractures.
OBJECTIVE
Recent meta-analyses have suggested similar wound infection rates when using single- or multiple-dose antibiotic prophylaxis in the operative management of closed long bone fractures. In order to assist clinicians in choosing the optimal prophylaxis strategy, we performed a cost-effectiveness analysis comparing single- and multiple-dose prophylaxis.


METHODS
A cost-effectiveness analysis comparing the two prophylactic strategies was performed using time horizons of 60 days and 1 year. Infection probabilities, costs, and quality-adjusted life days (QALD) for each strategy were estimated from the literature. All costs were reported in 2007 US dollars. A base case analysis was performed for the surgical treatment of a closed ankle fracture. Sensitivity analysis was performed for all variables, including probabilistic sensitivity analysis using Monte Carlo simulation.


RESULTS
Single-dose prophylaxis results in lower cost and a similar amount of quality-adjusted life days gained. The single-dose strategy had an average cost of $2,576 for an average gain of 272 QALD. Multiple doses had an average cost of $2,596 for 272 QALD gained. These results are sensitive to the incidence of surgical site infection and deep wound infection for the single-dose treatment arm. Probabilistic sensitivity analysis using all model variables also demonstrated preference for the single-dose strategy.


CONCLUSIONS
Assuming similar infection rates between the prophylactic groups, our results suggest that single-dose prophylaxis is slightly more cost-effective than multiple-dose regimens for the treatment of closed fractures. Extensive sensitivity analysis demonstrates these results to be stable using published meta-analysis infection rates.
Department of Orthopaedics, University of British Columbia, Vancouver, BC.
Gerard P
GP
Slobogean
Peter J
PJ
O'Brien
Carmen A
CA
Brauer
D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D019072:Antibiotic Prophylaxis / Q000191:economics*; D002437:Cefazolin / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D050723:Fractures, Bone / Q000601:surgery*; D005596:Fractures, Closed / Q000601:surgery*; D006801:Humans; D011336:Probability; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D002437:Cefazolin