Cost Effectiveness of Selective Decontamination of the Digestive Tract in Liver Transplant Patients

Enckevort, PJ van; Zwaveling, JH; Bottema, JT; Maring, JK; Klompmaker, I. J.; Slooff, Mjh; TenVergert, Elisabeth M.

doi:10.2165/00019053-200119050-00007

Cited by 14 publications

(4 citation statements)

References 23 publications

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“…Furthermore, alternative strategies have to be studied. Ideally, such a strategy would be at least as effective as SDD but less costly [74] and without risk of developing microbial drug resistance [75]. …”

Section: Antibiotic Prophylaxismentioning

confidence: 99%

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

Besselink

Timmerman²,

Minnen³

et al. 2005

Dig Surg

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Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal prophylactic strategy should act on all these factors, but such a strategy is not yet available. For several decades, antibiotic prophylaxis to prevent translocation of pathogenic bacteria has been studied with conflicting results. Selective decontamination of the digestive tract has shown good results, but fear for bacterial multiresistance has prevented worldwide implementation. In recent years, probiotics, living bacteria with a potential beneficial effect to their host, have shown promising results in several randomized placebo-controlled trials. Currently, in vitro and experimental research focuses on the effects of probiotics on the microflora responsible for gut-derived infections, structural mucosal barrier function and the immune system.

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Section: Antibiotic Prophylaxismentioning

confidence: 99%

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

Besselink

Timmerman²,

Minnen³

et al. 2005

Dig Surg

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“…Van der Voort et al [18] showed no effect of SDD and similar costs in ventilated patients in the ICU. In liver transplanted patients, SDD showed no benefits and additional costs [19]. These studies show that in high-risk patients (ICU), SDD generates the same or less costs, or no benefit (liver-transplanted patients) and higher costs.…”

Section: Discussionmentioning

confidence: 76%

Cost-Effectiveness of Perioperative Selective Decontamination of the Digestive Tract versus Placebo in Elective Gastrointestinal Surgery

et al. 2012

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Objective: We compared the routine use of perioperative selective decontamination of the digestive tract (SDD) for elective gastrointestinal surgery with placebo in a randomized controlled trial. Alongside this trial, a cost-effectiveness analysis from a provider perspective was performed. Methods and Results: A total of 289 patients undergoing elective surgery of the digestive tract were randomized to either SDD (143 patients) or placebo (146 patients). Routine use of SDD led to less patients with an infectious complication compared with placebo (p = 0.028). Mean total costs per patient were slightly less (EUR 2,604; 95% CI –6,292 to 1,084) in patients randomized to SDD (EUR 12,031) compared to patients randomized to placebo (EUR 14,635). Costs of hospitalization were the main determinant of the cost difference between the groups. The incremental cost-effectiveness ratio per prevented occurrence of ≥1 infectious complications per patient was –EUR 23,164, indicating the superiority of SDD over placebo. Conclusion: This study shows that in patients undergoing elective gastrointestinal surgery, the routine use of SDD is less expensive and economically more efficient than placebo in reducing the number of patients with infectious complications.

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“…SDD in patients undergoing liver transplantation has been estimated at $3100 USD (1997) per patient, inclusive of medication and surveillance cultures. (van Enckevort et al, 2001) Concern about costs of SDD needs to be balanced with cost savings from reducing HAIs At least four randomised controlled trials showing a lower cost per survivor when SDD was used. (Korinek et al, 1993, Rocha et al, 1992, Sanchez Garcia et al, 1998, Stoutenbeek et al, 1996 In a before-after study of antibiotic resistance and costs associated with SDD, no differences were reported in the total of ICU variable costs, microbiological and antibiotic costs between the 12 month period preceding the introduction of SDD and the 12 months thereafter.…”

Section: Discussionmentioning

confidence: 99%

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

et al. 2014

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Cost Effectiveness of Selective Decontamination of the Digestive Tract in Liver Transplant Patients

Cited by 14 publications

References 23 publications

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

Prevention of Infectious Complications in Surgical Patients: Potential Role of Probiotics

Cost-Effectiveness of Perioperative Selective Decontamination of the Digestive Tract versus Placebo in Elective Gastrointestinal Surgery

Implementing selective digestive tract decontamination in the intensive care unit: A qualitative analysis of nurse-identified considerations

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