Cost analysis of antibiotic prophylaxis in clean head and neck surgery
Blair E A, Johnson J T, Wagner R L, Carrau R L, Bizakis J G
Record Status
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
Health technology
Antibiotic prophylaxis in clean head and neck surgery.
Type of intervention
Secondary prevention.
Economic study type
Cost-effectiveness study.
Study population
The study population comprised patients who underwent clean neck dissection: patients with exposure to secretions from the upper aerodigestive tract were excluded. The mean age in the antibiotic prophylaxis group was 60 (range 24-91) and in the control group was 65 (27-91). There were 70 men and 23 women in the antibiotic prophylaxis group and 69 men and 30 women in the control group.
Setting
Hospital. The economic study was carried out in Pittsburgh, USA and Crete, Greece.
Dates to which data relate
Effectiveness and resource data were collected between 1976 -1989.1992 prices were used.
Source of effectiveness data
Single study.
Link between effectiveness and cost data
The costing was undertaken retrospectively on the same patient sample as that used in the effectiveness study.
Study sample
192 patients who underwent clean neck surgery.205 charts were analysed: patients with discontinuous surgery of the aerodigestive tract and patients needing antibiotics because of accidental entry in the aerodigestive tract were excluded. The authors acknowledged that more than 700 patients would be required for the results to reach statistical validity.
Study design
Retrospective cohort study.
Analysis of effectiveness
The analysis of the clinical study was based on treatment completers only. The primary health outcome used in the analysis was wound infection, defined as purulent drainage, with or without cellulitis or fistula, requiring antibiotics.
Effectiveness results
Wound infection developed in 10 (10%) of the 99 patients who did not receive perioperative prophylactic antibiotics. Of the 93 patients who received antibiotics, three (3.3%) developed wound infection. This difference was not statistically significant (p = 0.09)
Clinical conclusions
Perioperative antibiotics administration in clean neck surgery has possible therapeutical value and should not be withheld.
Measure of benefits used in the economic analysis
The benefits measured were the number of wound infections. No discounting was applied.
Direct costs
Direct health service costs were considered, namely hospital bills. Quantities and costs were analysed separately.1992 prices were used. No discounting has been applied.
Currency
US dollars ($).
Sensitivity analysis
Not performed.
Estimated benefits used in the economic analysis
Wound infection developed in 10% of the 99 patients who did not receive antibiotics and in 3.3% of the 93 patients who did.
Cost results
The excess cost for each patient who developed a postoperative wound infection was approximately $36,000. The cost of administration of antibiotic prophylaxis to 100 patients was less than this amount.
Synthesis of costs and benefits
Incremental benefits were shown to be positive (although not statistically significant), while incremental costs were negative. Antibiotic prophylaxis was, therefore, shown to be the dominant strategy.
Authors' conclusions
The decision to withhold antibiotic prophylaxis may not result in reduced hospital costs.
CRD Commentary
This was a straightforward study with clear answers to the initial question. The authors pointed out the statistical limitations of the study, proposing a 700 patient sample for statistical validity. The side effects of treatment and non-treatment, which could be important could also have been considered.
Implications of the study
A larger study incorporating quality of life measures is required.
Source of funding
Supported in part from a grant from the Mary Hillman Jennings Foundation, the John R McCune Foundation and the Eye & Ear Institute Foundation, Pittsburgh, Pa, USA.
Bibliographic details
Blair E A, Johnson J T, Wagner R L, Carrau R L, Bizakis J G. Cost analysis of antibiotic prophylaxis in clean head and neck surgery. Archives of Otolaryngology Head and Neck Surgery 1995; 121(3): 269-271