Selective decontamination of the digestive tract and selective oropharyngeal decontamination in intensive care unit patients: a cost-effectiveness analysis. Issue 3 (5th March 2013)

• Record Type: Journal Article
• Authors: Oostdijk, Evelien A N; de Wit, G A; Bakker, Marina; de Smet, Anne Marie G A; Bonten, M J M
• Other Names: contributor.; Kalkman Cor J author non-byline.; Joore Hans (J) C A author non-byline.; Leverstein-van Hall Maurine A. author non-byline.; Blok Hetty E M author non-byline.; Kluytmans Jan A J W author non-byline.; van der Meer Nardo J M author non-byline.; Mascini Ellen M author non-byline.; Kaasjager Karin author non-byline.; Bosch Frank H author non-byline.; Benus Robin F J author non-byline.; van der Werf Tjip S author non-byline.; Arends Jan P author non-byline.; van der Hoeven Johannes G author non-byline.; Pickkers Peter author non-byline.; Sturm Patrick D J author non-byline.; Voss Andreas author non-byline.; Bernards Alexandra T author non-byline.; Kuijper Ed J author non-byline.; Harinck Hubertus I J author non-byline.; Bindels Alexander J G H author non-byline.; Jansz Arjan R author non-byline.; Wesselink Ronald M J author non-byline.; Bartelt M de Jongh author non-byline.; Dennesen Paul J W author non-byline.; van Asselt Gerard J author non-byline.; te Velde Leonard F author non-byline.; Frenay Ine H M E author non-byline.; van Iterson Mat author non-byline.; Thijsen Steven F T author non-byline.; Kluge Georg H author non-byline.; de Vries Jacob W author non-byline.; Kaan Jan A author non-byline.;
• Is Part Of: BMJ open. Volume 3:Issue 3(2013)
• Publication Date: 2013-03-05
• Subjects: Health economics; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2012-002529
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs). Design: A post hoc analysis of a previously performed cluster-randomised trial ( NEJM 2009;360:20). Setting: 13 Dutch ICUs. Participants: Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990). Interventions: SDD or SOD. Primary and secondary outcome measures: Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation. Results: Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving. Conclusions: SDD and SOD were both effective and cost-saving in Dutch ICUs.