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Selecting cost-effective antimicrobial prophylaxis in surgery: are we getting what we pay for?
A C Roach1, D S Kernodle, A B Kaiser
1Department of Pharmacy, Saint Thomas Hospital, Nashville, TN 37202.
DICP : the Annals of Pharmacotherapy
|February 1, 1990
Summary
Cefamandole is more cost-effective than cefazolin for cardiac surgery prophylaxis, despite higher initial costs. Including infection treatment expenses reveals cefamandole
Area of Science:
- Pharmacoeconomics
- Infectious Diseases
- Surgical Prophylaxis
Background:
- Antimicrobial prophylaxis is crucial in cardiac surgery to prevent surgical site infections.
- The cost-effectiveness of prophylactic agents requires evaluating not only acquisition and administration but also treatment of treatment failures.
Purpose of the Study:
- To compare the costs associated with cefazolin and cefamandole prophylaxis in cardiac surgery.
- To determine the most cost-effective prophylactic agent by including infection-related expenses.
Main Methods:
- Prospective randomized comparison of cefazolin versus cefamandole for antimicrobial prophylaxis.
- Cost analysis encompassing acquisition, administration, and treatment of wound infections following prophylaxis.
Main Results:
- Cefamandole exhibited higher acquisition and administration costs compared to cefazolin.
- However, cefamandole proved more cost-effective due to significantly lower expenses related to treating wound infections that occurred despite prophylaxis (mean total costs: $315 for cefamandole vs. $766 for cefazolin).
Conclusions:
- When evaluating prophylactic antimicrobials, the costs associated with 'prophylactic failures' must be considered.
- The least expensive agent for the pharmacy may not be the most cost-effective choice for the healthcare institution.