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• W2037760044 abstract "728 Introduction Efficacy and cost-effectiveness of selective decontamination (SD) of the bowel to prevent infections in patients undergoing liver transplantation are still debated. Therefore, a randomised placebo-controlled trial was performed with an integrated economic evaluation. Results of the economic evaluation, which to our knowledge is the first full economic evaluation of SD in liver transplantation, will be presented. Patients and Methods Patients of two university hospitals in the Netherlands were randomised to receive either SD or placebo as soon as they were accepted for elective liver transplantation. Patients on SD had a preoperative regimen consisting of oral norfloxacin 400 mg once daily and lozenges containing 2 mg colistine, 1,8 mg tobramycin and 10 mg amphotericin B, four times daily. Postoperatively, patients received a suspension containing 200 mg colistine, 80 mg tobramycin and 500 mg amphotericin B, four times daily through the nasogastric tube, combined with an oral paste containing a 2% solution of the same drugs. Patients on placebo were on a similar regimen with placebo drugs. An economic evaluation was performed with postoperative infection episodes (till 30 days after transplantation) as effect parameter. As infection episodes did not differ between groups, a cost minimisation analysis was performed, in which incremental costs were assessed. Besides costs related to SD (medication and routine cultures) other direct medical costs (e.g. hospitalisation, outpatient visits, services, other medication) were determined, both pre- and postoperatively (till 30 days after transplantation). True resource costs were assessed against unit prices of 1997. Costs were compared with a Mann-Whitney U test. A p-value of <0.05 was considered significant. All analyses were by per protocol analysis. Results Pre-operative costs were based on 58 patients: 29 in the SD group and 29 in the placebo group. Post-operative costs and infections were based on 55 patients: 26 in the SD group and 29 in the placebo group (3 SD patients died during or immediately after transplantation and were excluded). Costs of SD medication and routine cultures were evidently higher in the SD group; on average $3,300 per patient. The other direct medical costs did not significantly differ between both groups, and became $28,900 and $29,200 in, respectively, the SD and the placebo group. As no differences in other costs existed, incremental costs of SD did not differ from the additional costs of SD medication and routine cultures. There was no significant difference in infection episodes. Conclusions SD leads to additional costs of SD medication and routine cultures, whereas no savings in other costs are realised. Besides that, no improvement in infection episodes is realised by SD. Consequently, SD is a non-efficient approach in liver transplants." @default.
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• W2037760044 date "1999-04-01" @default.
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• W2037760044 title "COST-EFFECTIVENESS OF DECONTAMINATION OF THE DIGESTIVE TRACT IN LIVER TRANSPLANTATION" @default.
• W2037760044 doi "https://doi.org/10.1097/00007890-199904150-00753" @default.
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