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Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital |
Gyssens I C, Geerligs I E, Dony J M, van der Vliet J A, van Kampen A, van den Broek P J, Hekster Y A, van der Meer J W |
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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 Antimicrobial drug use in surgery.
Type of intervention Primary prevention; Treatment.
Economic study type Cost-effectiveness analysis.
Study population Male and female consecutive surgical patients before and after a period of intervention.
Setting University hospital: departments of gynaecology and obstetrics (G), surgery (S) and orthopaedic surgery (O). The economic study was carried out in The Netherlands.
Dates to which data relate The main effectiveness data were taken from a single trial conducted in 1990 and 1992. Resource and cost data were mainly derived from 1990-92 sources. The price year was not given.
Source of effectiveness data The estimates of the number of operations, median length of hospital stay, prophylactic and therapeutic course, prophylactic and therapeutic antimicrobial drugs prescribed, and compliance with guidelines were derived from a single study.
Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample as that used in the effectiveness study.
Study sample The study involved a cohort of 766 (G=331, S=286 and O=149) and 744 (G=282, S=302 and O=160) consecutive surgical patients before and after a period of intervention. The intervention was the introduction of a new edition of an antimicrobial drug formulary and surgical department treatment protocols. Power calculations to determine the sample size were not undertaken.
Study design Nonrandomized trial with historical controls. The duration of the follow-up and the loss to follow-up were not stated.
Analysis of effectiveness The analysis of the effectiveness was based on treatment completers only. The primary effectiveness and health outcomes used in the analysis were median length of hospital stay, compliance with guidelines, number of infections, and prophylactic and therapeutic antimicrobial drugs prescribed.
Effectiveness results The stable median length of stay was 5.5 days before the intervention and 5.0 days after the intervention. Compliance with guidelines was 32% in the before intervention group (G=15%, S=32% and O=47%) and 79% in the after intervention group (G=66%, S=90% and O=74%)(p=0.005). The number of infections treated with antimicrobial drugs/100 bed days was 1.0 before and 0.7 after intervention. The prophylactic Defined Daily Dose/operation was 0.75 before (G=0.91, S=0.65 and O=0.76) and 0.53 after (G=0.78, S=0.45 and O=0.41) (p=0.005). The therapeutic Defined Daily Dose/100 bed days was 18.1 (G=13.6, S=20.9 and O=18.2) and 31.0 (G=17.7, S=30.6 and O=47.9) in the before and after intervention group, respectively (p=0.005).
Clinical conclusions The quality of prophylactic courses improved.
Measure of benefits used in the economic analysis The measures of benefit were median length of hospital stay, compliance with guidelines, number of infections, and prophylactic and therapeutic antimicrobial drugs prescribed.
Direct costs Prophylactic and therapeutic costs were included in the analysis. The quantities were analysed separately from the prices. The quantity/cost boundary adopted was the hospital. Discounting was not undertaken. The price year was not given.
Statistical analysis of costs Currency Dutch guilders and UK pounds Sterling (). A conversion rate of Dfl1 = 0.38 was applied.
Estimated benefits used in the economic analysis The stable median length of stay was 5.5 days before the intervention and 5.0 days after the intervention. Compliance with guidelines was 32% in the before intervention group (G=15%, S=32% and O=47%) and 79% in the after intervention group (G=66%, S=90% and O=74%)(p=0.005). The number of infections treated with antimicrobial drugs/100 bed days was 1.0 before and 0.7 after intervention. The prophylactic Defined Daily Dose/operation was 0.75 before (G=0.91, S=0.65 and O=0.76) and 0.53 after (G=0.78, S=0.45 and O=0.41) (p=0.005). The therapeutic Defined Daily Dose/100 bed days was 18.1 (G=13.6, S=20.9 and O=18.2) and 31.0 (G=17.7, S=30.6 and O=47.9) in the before and after intervention group, respectively (p=0.005).
Cost results Total costs were 14,131 before the intervention and 12,562 after the intervention. Discounting was not undertaken.
Synthesis of costs and benefits A synthesis of the estimated benefits and costs was not provided. Dominance of the intervention was demonstrated. An incremental analysis was performed. Total cost savings were estimated to be 11%.
Authors' conclusions Antimicrobial drug usein a surgical department improved both in terms of quality and costs with the introduction of new guidelines.
CRD COMMENTARY - Selection of comparators The reason for the choice of comparator is clear. Monitoring antimicrobial drug use is widely used to limit and reduce the spread of resistant microorganisms and to contain costs. You, as a user of this database, should consider whether these are widely used health technologies in your setting.
Validity of estimate of measure of benefit The estimate of measure of benefit used in the economic analysis is likely to be internally valid. The data have not been used selectively.
Validity of estimate of costs The resource quantities were reported separately from the prices. Adequate details of methods of quantity/cost estimation were not given. Costs were not specifically itemized.
Other issues The authors' conclusions were justified, given the uncertainties in the data. The issue of generalisability to other settings/countries was not addressed. Appropriate comparisons were not made with other studies. Results were not presented selectively.
Bibliographic details Gyssens I C, Geerligs I E, Dony J M, van der Vliet J A, van Kampen A, van den Broek P J, Hekster Y A, van der Meer J W. Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital. Journal of Antimicrobial Chemotherapy 1996; 38(6): 1001-1012 Indexing Status Subject indexing assigned by NLM MeSH Anti-Infective Agents /therapeutic use; Cross Infection /prevention & Drug Therapy /economics /utilization; Hospitals, University; Humans; Prospective Studies; Quality Control; Surgical Procedures, Operative /economics /methods; control AccessionNumber 21997000245 Date bibliographic record published 31/10/1998 Date abstract record published 31/10/1998 |
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