Measuring the cost-effectiveness of antibiotic prophylaxis in surgery

Cost-effectiveness analysis is primarily a decision-making aid for budget holders. The first questions that must be answered are: Costs to whom? Effects on whom? Ideally cost-effectiveness analysis should address these questions separately from the perspective of the hospital, the community health services, the patient, and society in general. However, it may not always be practical to perform such a wide-ranging study. Moreover, if the decision maker is primarily concerned with the hospital budget, it is tempting to confine the detailed analysis to items that affect that budget. A good analysis should acknowledge these inevitable limitations and explicitly state whose perspective is being used. Even if a detailed study of community health services is not possible, the analysis should include some evidence about the likely impact of the program on others outside the immediate sphere of the budget holder. Two situations commonly arise in applying cost-effectiveness analysis to surgical prophylaxis: (a) The prophylaxis is more expensive than current practice and its costs must be justified, e.g., the use of a more expensive drug for a recognized indication or the introduction of prophylaxis for a new indication. (b) The prophylaxis is cheaper than current practice and must be shown to be as cost-effective, e.g., the use of a single-dose prophylaxis instead of multiple-dose regimens or the administration of an oral dose instead of an intravenous dose. We believe that cost-effectiveness analysis adds a useful extra dimension to the evaluation of surgical prophylaxis.