A Cost-effectiveness Evaluation of 3 Antimicrobial Regimens for the Prevention of Infective Complications After Abdominal Surgery

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Abstract
Objective: To measure the cost and effectiveness of 3 established antimicrobial regimens for the prevention of infective complications after abdominal surgery. Design: A prospective randomized trial was performed involving a total of 1070 patients undergoing abdominal surgery. Setting and Patients: All patients having upper gastrointestinal tract, colorectal, appendiceal, or biliary surgery at a major teaching hospital in Melbourne, Australia, were considered for entry into the study. Interventions: Patients were randomized prior to surgery to receive a single dose of cefotaxime sodium (1 g), ticarcillin plus clavulanic acid (3.1 g), or ceftriaxone sodium (1 g). All drugs were given intravenously at the start of anesthesia. Main Outcome Measures: Rates of major wound infections, minor wound infections, other wound problems, and other infective complications. The acquisition and administrative costs of the drugs used and the costs of the infective complications were measured. Results: A total of 1070 patients were entered into the study. Major wound infections occurred in 21 patients (2.0%). Twenty-five patients (2.3%) developed a minor wound infection. Other infective complications developed in 107 patients. There were significantly fewer minor wound infections in the ceftriaxone-treated group as compared with the other 2 groups. There was no difference in the frequency of major wound infections, other wound problems, or other infective complications. The acquisition costs of cefotaxime and ticarcillin plus clavulanic acid were less than those of ceftriaxone. The estimated cost of treating the infective complications in the group of patients who received ticarcillin plus clavulanic acid ($128 039) was greater than the cost associated with the groups being treated with cefotaxime ($91 243) or ceftriaxone ($96 095). Conclusions: The study indicates that each of the 3 regimens was associated with highly satisfactory control of postoperative infective complications after abdominal surgery. On the basis of the estimated costs of infective complications, cefotaxime and ceftriaxone appear equally effective for the prevention of infective complications after abdominal surgery. Acquisition costs for cefotaxime were lower and it is recommended as the preferred agent on this basis. Arch Surg. 1996;131:744-748