Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy
Background: Clinical findings suggest that the use of rectal culture-guided antibiotic prophylaxis reduces the infection rate following transrectal ultrasound-guided prostate biopsy (TRUSBx). Methods: A decision-analytic model was designed to compare the outcomes of TRUSBx performed with (rectal cul...
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doaj-99d1fc75dd794364bb7c8b9eac2386d72020-11-24T23:44:51ZengElsevierInternational Journal of Infectious Diseases1201-97121878-35112016-02-0143C71210.1016/j.ijid.2015.12.005Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsyChi-kong LiBrian C.Y. TongJoyce H.S. YouBackground: Clinical findings suggest that the use of rectal culture-guided antibiotic prophylaxis reduces the infection rate following transrectal ultrasound-guided prostate biopsy (TRUSBx). Methods: A decision-analytic model was designed to compare the outcomes of TRUSBx performed with (rectal culture-guided group) and without (standard ciprofloxacin prophylaxis) rectal swab culture-guided antimicrobial prophylaxis in Hong Kong. The post-biopsy infection rate, infection-related costs, quality-adjusted life years (QALYs) lost for infection, and incremental cost per QALY saved (ICER) were assessed. Model inputs were retrieved from local epidemiology data and the medical literature. A sensitivity analysis was performed to test the robustness of the model results. Results: Base-case analysis showed that the infection rate in the culture-guided group was reduced from 2.42% to 0.23% and saved 0.0002 QALYs, with a lower cost (USD 31.4 versus USD 55.6) (USD 1 = HKD 7.8). The number needed to screen to prevent an infection episode was 45.7. The hospital days avoided per 100 patients using culture-guided prophylaxis was 7.08 days. The relative effectiveness of culture-guided antimicrobial prophylaxis versus standard prophylaxis in carriers and non-carriers of FQ-resistant rectal flora were identified as potential influencing factors. In 10 000 Monte Carlo simulations, ICERs of the culture-guided group were below the willingness-to-pay threshold 99.12% of the time. Conclusions: Using rectal culture-guided antimicrobial prophylaxis for men undergoing TRUSBx appears to be a cost-saving strategy to avert post-biopsy infection and QALY loss in Hong Kong.http://www.sciencedirect.com/science/article/pii/S1201971215002866Antimicrobial prophylaxisRectal cultureProstate biopsyPost-biopsy infectionCost-effectiveness analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chi-kong Li Brian C.Y. Tong Joyce H.S. You |
spellingShingle |
Chi-kong Li Brian C.Y. Tong Joyce H.S. You Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy International Journal of Infectious Diseases Antimicrobial prophylaxis Rectal culture Prostate biopsy Post-biopsy infection Cost-effectiveness analysis |
author_facet |
Chi-kong Li Brian C.Y. Tong Joyce H.S. You |
author_sort |
Chi-kong Li |
title |
Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
title_short |
Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
title_full |
Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
title_fullStr |
Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
title_full_unstemmed |
Cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
title_sort |
cost-effectiveness of culture-guided antimicrobial prophylaxis for the prevention of infections after prostate biopsy |
publisher |
Elsevier |
series |
International Journal of Infectious Diseases |
issn |
1201-9712 1878-3511 |
publishDate |
2016-02-01 |
description |
Background: Clinical findings suggest that the use of rectal culture-guided antibiotic prophylaxis reduces the infection rate following transrectal ultrasound-guided prostate biopsy (TRUSBx).
Methods: A decision-analytic model was designed to compare the outcomes of TRUSBx performed with (rectal culture-guided group) and without (standard ciprofloxacin prophylaxis) rectal swab culture-guided antimicrobial prophylaxis in Hong Kong. The post-biopsy infection rate, infection-related costs, quality-adjusted life years (QALYs) lost for infection, and incremental cost per QALY saved (ICER) were assessed. Model inputs were retrieved from local epidemiology data and the medical literature. A sensitivity analysis was performed to test the robustness of the model results.
Results: Base-case analysis showed that the infection rate in the culture-guided group was reduced from 2.42% to 0.23% and saved 0.0002 QALYs, with a lower cost (USD 31.4 versus USD 55.6) (USD 1 = HKD 7.8). The number needed to screen to prevent an infection episode was 45.7. The hospital days avoided per 100 patients using culture-guided prophylaxis was 7.08 days. The relative effectiveness of culture-guided antimicrobial prophylaxis versus standard prophylaxis in carriers and non-carriers of FQ-resistant rectal flora were identified as potential influencing factors. In 10 000 Monte Carlo simulations, ICERs of the culture-guided group were below the willingness-to-pay threshold 99.12% of the time.
Conclusions: Using rectal culture-guided antimicrobial prophylaxis for men undergoing TRUSBx appears to be a cost-saving strategy to avert post-biopsy infection and QALY loss in Hong Kong. |
topic |
Antimicrobial prophylaxis Rectal culture Prostate biopsy Post-biopsy infection Cost-effectiveness analysis |
url |
http://www.sciencedirect.com/science/article/pii/S1201971215002866 |
work_keys_str_mv |
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