Cost-effectiveness analysis of antibiotic prophylaxis versus no antibiotic prophylaxis for acute cholecystectomy.

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Maya Satheeskaran, Aminah Hussan, Ailin Anto, Laure de Preux
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Abstract

Objective: For acute cholecystitis, the treatment of choice is laparoscopic cholecystectomy. In mild-to-moderate cases, the use of antibiotic prophylaxis for the prevention of postoperative infectious complications (POICs) lacks evidence regarding its cost-effectiveness when compared with no prophylaxis. In the context of rising antimicrobial resistance, there is a clear rationale for a cost-effectiveness analysis (CEA) to determine the most efficient use of National Health Service resources and antibiotic routine usage.

Design: 16 of 226 patients (7.1%) in the single-dose prophylaxis group and 29 of 231 (12.6%) in the non-prophylaxis group developed POICs. A CEA was carried out using health outcome data from thePerioperative antibiotic prophylaxis in the treatment of acute cholecystitis (PEANUTS II) multicentre, randomised, open-label, non-inferiority, clinical trial. Costs were measured in monetary units using pound sterling, and effectiveness expressed as POICs avoided within the first 30 days after cholecystectomy.

Results: This CEA produced an incremental cost-effectiveness ratio of -£792.70. This suggests a modest cost-effectiveness of antibiotic prophylaxis being marginally less costly and more effective than no prophylaxis. Three sensitivity analyses were executed considering full adherence to the antibiotic, POICs with increased complexity and break-point analysis suggesting caution in the recommendation of systematic use of antibiotic prophylaxis for the prevention of POICs.

Conclusion: The results of this CEA point to greater consensus in UK-based guidelines surrounding the provision of antibiotic prophylaxis for mild-to-moderate cases of acute cholecystitis.

Abstract Image

Abstract Image

抗生素预防与非抗生素预防急性胆囊切除术的成本-效果分析。
目的:对于急性胆囊炎,治疗方法选择腹腔镜胆囊切除术。在轻度至中度病例中,使用抗生素预防术后感染性并发症(POICs)与不进行预防相比,缺乏成本效益方面的证据。在抗微生物耐药性不断上升的背景下,成本效益分析(CEA)有明确的理由来确定国家卫生服务资源的最有效使用和抗生素的常规使用。设计:单剂量预防组226名患者中有16名(7.1%)和非预防组231名患者中的29名(12.6%)出现POICs。CEA是利用围手术期抗生素预防治疗急性胆囊炎(PEANUTS II)多中心、随机、开放标签、非劣效性临床试验的健康结果数据进行的。成本使用英镑以货币单位计量,有效性表示为胆囊切除术后前30天内避免的POIC。结果:该CEA产生了792.70英镑的增量成本效益比。这表明,抗生素预防的成本效益适中,比不预防的成本略低,更有效。考虑到对抗生素的完全依从性,进行了三次敏感性分析,POICs的复杂性增加,断点分析表明,在建议系统使用抗生素预防预防POICs时要谨慎。结论:该CEA的结果表明,英国指南中对轻度至中度急性胆囊炎的抗生素预防有更大的共识。
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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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