title: Preoperative screening strategies for bacterial vaginosis prior to elective hysterectomy: a cost comparison study.
abstract: OBJECTIVE
  The purpose of this study is to compare costs of 3 strategies for women undergoing hysterectomy: (1) test all patients for bacterial vaginosis; treat if positive; (2) treat all patients for bacterial vaginosis; (3) neither test nor treat patients for bacterial vaginosis. For comparison purposes, a fourth strategy is examined: (4) no surgical site infection prophylaxis or bacterial vaginosis treatment.
  
  
  METHODS
  A cost minimization model was created using estimates obtained from the published literature, Medicare reimbursement data, and wholesale drug costs.
  
  
  RESULTS
  In the base case, the optimal strategy was to treat all patients for bacterial vaginosis, with a cuff infection rate of 4.0% and mean cost of $593. The "test all patients for bacterial vaginosis; treat if positive" strategy was also inexpensive, with a mean cost of $623 and 4.2% cuff infection rate. "Neither test nor treat patients for bacterial vaginosis" and "no surgical site infection prophylaxis or bacterial vaginosis treatment" were more expensive and less effective than other strategies.
  
  
  CONCLUSIONS
  This model suggests that consideration should be given to adding metronidazole to standard surgical site infection prophylaxis before hysterectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA. kara.mcelligott@duke.edu
authors.forename: Kara A
authors.initials: KA
authors.lastname: McElligott
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D008795:Metronidazole / Q000627:therapeutic use; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole