Related Experiment Video
Updated: Dec 10, 2025
Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
Published on: January 10, 2019
The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy
Yehuda E Kerbel1, Gregory J Kirchner1, Anisha Reddy Sunkerneni1
112312Drexel University, Philadelphia, PA, USA.
Study Design:
Break-even cost analysis.
Objective:
The goal of this study is to examine the cost-effectiveness of vancomycin powder for preventing infection following lumbar laminectomy.
Methods:
The product cost of vancomycin powder was obtained from our institution's purchasing records. Infection rates and revision costs for lumbar laminectomy and lumbar laminectomy with fusion were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic application of vancomycin powder cost-effective. Analysis of lumbar laminectomy with fusion was performed for comparison.
Results:
Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in lumbar laminectomy if the infection rate of 4.2% decreased by an ARR of 0.015%. Laminectomy with fusion was also determined to be cost-effective at the same cost of vancomycin powder if the infection rate of 8.5% decreased by an ARR of 0.0034%. The current highest cost reported in the literature, $44.00 per gram of vancomycin powder, remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively. Varying the baseline infection rate did not influence the ARR for either procedure when the analysis was performed using the product cost of vancomycin at our institution.
Conclusions:
This break-even analysis demonstrates that prophylactic vancomycin powder can be highly cost-effective for lumbar laminectomy. At our institution, vancomycin powder is economically justified if it prevents at least one infection out of 6700 lumbar laminectomy surgeries.
Insights
Prophylactic vancomycin powder is cost-effective for lumbar laminectomy, potentially preventing infections and reducing healthcare costs. This analysis shows economic justification even at higher drug prices.
Area of Science:
- Spinal Surgery
- Infectious Disease Prevention
- Health Economics
Background:
- Surgical site infections (SSIs) following lumbar laminectomy pose significant risks and increase healthcare expenditures.
- Prophylactic antibiotic strategies are crucial for mitigating SSIs in spinal procedures.
- The cost-effectiveness of specific prophylactic agents, like vancomycin powder, requires rigorous economic evaluation.
Purpose of the Study:
- To evaluate the cost-effectiveness of using vancomycin powder for infection prevention in patients undergoing lumbar laminectomy.
- To determine the threshold for infection rate reduction (absolute risk reduction) at which vancomycin powder becomes economically justifiable.
- To compare the cost-effectiveness of vancomycin powder in lumbar laminectomy versus lumbar laminectomy with fusion.
Main Methods:
- A break-even cost analysis was conducted.
- Institutional purchasing records provided the cost of vancomycin powder.
- Infection rates and revision costs were sourced from existing literature for lumbar laminectomy and lumbar laminectomy with fusion.
Main Results:
- Vancomycin powder at $3.06/gram is cost-effective for lumbar laminectomy if infection rates decrease by an absolute risk reduction (ARR) of 0.015%.
- For lumbar laminectomy with fusion, vancomycin powder is cost-effective with an ARR of 0.0034% at the same institutional cost.
- Even at a literature-reported high cost of $44.00/gram, vancomycin powder remained cost-effective with ARRs of 0.21% and 0.048% for laminectomy and laminectomy with fusion, respectively.
Conclusions:
- Prophylactic vancomycin powder demonstrates high cost-effectiveness for lumbar laminectomy procedures.
- Economically, vancomycin powder is justified at the institution if it prevents at least one infection in every 6700 lumbar laminectomy surgeries.
- The findings support the routine use of vancomycin powder to reduce infection rates and associated costs in spinal surgery.
Related Concept Videos
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:22Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence