title: Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs).
  
  
  METHODS
  A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20).
  
  
  METHODS
  13 Dutch ICUs.
  
  
  METHODS
  Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990).
  
  
  METHODS
  SDD or SOD.
  
  
  METHODS
  Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation.
  
  
  RESULTS
  Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving.
  
  
  CONCLUSIONS
  SDD and SOD were both effective and cost-saving in Dutch ICUs.
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Evelien A N
authors.initials: EA
authors.lastname: Oostdijk
authors.forename: G A
authors.initials: GA
authors.lastname: de Wit
authors.forename: Marina
authors.initials: M
authors.lastname: Bakker
authors.forename: Anne Marie G A
authors.initials: AM
authors.lastname: de Smet
authors.forename: M J M
authors.initials: MJ
authors.lastname: Bonten