Cost and benefit of perioperative antimicrobial prophylaxis: methods for economic analysis

Cost-benefit analysis of perioperative prophylaxis with antimicrobial agents involves efforts in two main areas: first, economic aspects of a decision whether or not to use prophylaxis are examined; and second, the financial benefit of a drug or regimen is compared with that of the currently used drug or regimen. Both cost and benefit have a number of components, both direct and indirect; methods are available for the analysis of some of these components. Systematic economic analysis permits evaluation of the relative importance and magnitude of the various elements of cost and benefit. Often the analysis shows that information about one or more elements is not worth collecting because it will have minor or no impact. Failure to clearly identify the viewpoints of persons interpreting the data hinders analysis; systematic economic analysis makes these differences in viewpoint clearer. Convincing economic data in favor of prophylaxis exist for some operative procedures; hospitals should insist that these regimens be implemented. Surgical wound infection is the only type of nosocomial infection for which a consistent drop in rate of occurrence has been seen during the past decade. This drop undoubtedly is related in part to the perioperative use of antimicrobial agents. Perhaps these results constitute the best cost-benefit assessment of all.