Cost-effectiveness of single dose cefotaxime plus metronidazole compared with three doses each of cefuroxime plus metronidazole for the prevention of wound infection after colorectal surgery

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Abstract
The cost-effectiveness of prophylaxis for colonic surgery with single dose cefotaxime plus metronidazole has been compared with that of three doses each of cefuroxime plus metronidazole, by analysing data from a previously published study supplemented with additional data on the hospital and community costs of wound infection after colonic surgery. The original trial included 942 patients having elective colonic surgery in 14 hospitals. The data on costs of wound infection were collected from a further 124 patients undergoing elective colonic surgery at Ninewells Hospital. All these patients received a three dose regimen of cefuroxime plus metronidazole. The Dundee patients received three injections of 0·75 g cefuroxime at 8-hourly intervals whereas the trial patients received a single dose of 1·5 g followed by two further doses of 0·75g at 8-hourly intervals. The cefuroxime prophylaxis regimen used in the trial cost λ24.16 per patient more than the cefotaxime regimen. The components of the excess cost were drugs (λ15.18), equipment (λ6.14) and staff time (λ2.84). The median cost to the hospital of a wound infection was λ978.04 (95% CI λ482.04 to λ1521.22). The components of the hospital cost of wound infection were: hotel costs λ858 (88%), dressing costs λ83.02 (8%) and drug costs (excluding prophylaxis) λ37.02 (4%). Only five patients received additional antibiotic treatment in the community, and only one required home visits from the District Nurse. Applying the difference in costs of prophylaxis as λ21 (costs of drugs plus equipment) and the cost per wound infection as λ1000 to the observed wound infection rate of 7% in the cefuroxime group, the wound infection rate in the cefotaxime group would have to be 2·1% higher for the two regimens to be equally cost-effective. The probability that such a difference in efficacy exists is 0-088. A model was developed to calculate the probability of equal cost-effectiveness over a range of costs of wound infection.

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