Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis.
Administration, Topical
Aged
Amphotericin B
/ economics
Anti-Bacterial Agents
/ economics
Antifungal Agents
/ economics
Carrier State
/ drug therapy
Cephalosporins
/ therapeutic use
Colistin
/ economics
Cost-Benefit Analysis
Cross Infection
/ economics
Decontamination
Drug Resistance, Microbial
Female
Gastrointestinal Tract
/ microbiology
Health Care Costs
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
/ economics
Male
Middle Aged
Netherlands
Oropharynx
/ microbiology
Randomized Controlled Trials as Topic
Tobramycin
/ economics
cost-effectiveness
individual patient data meta-analysis
intensive care medicine
selective digestive decontamination
selective oropharyngeal decontamination
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
06 09 2019
06 09 2019
Historique:
entrez:
9
9
2019
pubmed:
9
9
2019
medline:
29
9
2020
Statut:
epublish
Résumé
To determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance. Post-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials. 24 ICUs in the Netherlands. 12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232). SDD versus SOD. The incremental cost-effectiveness ratio (ICER; ie, costs to prevent one in-hospital death) was calculated by comparing differences in direct healthcare costs and in-hospital mortality of patients treated with SDD versus SOD. A willingness-to-pay curve was plotted to reflect the probability of cost-effectiveness of SDD for a range of different values of maximum costs per prevented in-hospital death. The ICER resulting from the fixed-effect meta-analysis, adjusted for clustering and differences in baseline characteristics, showed that SDD significantly reduced in-hospital mortality (adjusted absolute risk reduction 0.0195, 95% CI 0.0050 to 0.0338) with no difference in costs (adjusted cost difference €62 in favour of SDD, 95% CI -€1079 to €935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of €33 633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD. In Dutch ICUs, SDD has a very high probability of cost-effectiveness as compared to SOD. These data support the implementation of SDD in settings with low levels of antimicrobial resistance.
Identifiants
pubmed: 31494605
pii: bmjopen-2018-028876
doi: 10.1136/bmjopen-2018-028876
pmc: PMC6731916
doi:
Substances chimiques
Anti-Bacterial Agents
0
Antifungal Agents
0
Cephalosporins
0
Amphotericin B
7XU7A7DROE
Tobramycin
VZ8RRZ51VK
Colistin
Z67X93HJG1
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e028876Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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