Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis
Objective To determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance.Design Post-hoc analysis of a previously performed individual patient dat...
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| Format: | Article |
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e028876.full |
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| author | Marc J M Bonten Denise van Hout Nienke L Plantinga Patricia C Bruijning-Verhagen Evelien A N Oostdijk Anne Marie G A de Smet G Ardine de Wit Cornelis H van Werkhoven |
| author_facet | Marc J M Bonten Denise van Hout Nienke L Plantinga Patricia C Bruijning-Verhagen Evelien A N Oostdijk Anne Marie G A de Smet G Ardine de Wit Cornelis H van Werkhoven |
| author_sort | Marc J M Bonten |
| collection | DOAJ |
| description | Objective To determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance.Design Post-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.Setting 24 ICUs in the Netherlands.Participants 12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232).Interventions SDD versus SOD.Primary and secondary outcome measures The incremental cost-effectiveness ratio (ICER; ie, costs to prevent one in-hospital death) was calculated by comparing differences in direct healthcare costs and in-hospital mortality of patients treated with SDD versus SOD. A willingness-to-pay curve was plotted to reflect the probability of cost-effectiveness of SDD for a range of different values of maximum costs per prevented in-hospital death.Results The ICER resulting from the fixed-effect meta-analysis, adjusted for clustering and differences in baseline characteristics, showed that SDD significantly reduced in-hospital mortality (adjusted absolute risk reduction 0.0195, 95% CI 0.0050 to 0.0338) with no difference in costs (adjusted cost difference €62 in favour of SDD, 95% CI –€1079 to €935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of €33 633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD.Conclusion In Dutch ICUs, SDD has a very high probability of cost-effectiveness as compared to SOD. These data support the implementation of SDD in settings with low levels of antimicrobial resistance. |
| format | Article |
| id | doaj-art-93c37945806d42989073c8f6938ea0f7 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-93c37945806d42989073c8f6938ea0f72025-02-10T14:35:13ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2018-028876Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysisMarc J M Bonten0Denise van Hout1Nienke L Plantinga2Patricia C Bruijning-Verhagen3Evelien A N Oostdijk4Anne Marie G A de Smet5G Ardine de Wit6Cornelis H van Werkhoven7Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands2 University Utrecht, Utrecht, The Netherlands1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands5 Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Intensive Care Medicine, UMC Utrecht, Utrecht, The NetherlandsJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The NetherlandsObjective To determine the cost-effectiveness of selective digestive decontamination (SDD) as compared to selective oropharyngeal decontamination (SOD) in intensive care units (ICUs) with low levels of antimicrobial resistance.Design Post-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.Setting 24 ICUs in the Netherlands.Participants 12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232).Interventions SDD versus SOD.Primary and secondary outcome measures The incremental cost-effectiveness ratio (ICER; ie, costs to prevent one in-hospital death) was calculated by comparing differences in direct healthcare costs and in-hospital mortality of patients treated with SDD versus SOD. A willingness-to-pay curve was plotted to reflect the probability of cost-effectiveness of SDD for a range of different values of maximum costs per prevented in-hospital death.Results The ICER resulting from the fixed-effect meta-analysis, adjusted for clustering and differences in baseline characteristics, showed that SDD significantly reduced in-hospital mortality (adjusted absolute risk reduction 0.0195, 95% CI 0.0050 to 0.0338) with no difference in costs (adjusted cost difference €62 in favour of SDD, 95% CI –€1079 to €935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of €33 633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD.Conclusion In Dutch ICUs, SDD has a very high probability of cost-effectiveness as compared to SOD. These data support the implementation of SDD in settings with low levels of antimicrobial resistance.https://bmjopen.bmj.com/content/9/9/e028876.full |
| spellingShingle | Marc J M Bonten Denise van Hout Nienke L Plantinga Patricia C Bruijning-Verhagen Evelien A N Oostdijk Anne Marie G A de Smet G Ardine de Wit Cornelis H van Werkhoven Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis BMJ Open |
| title | Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis |
| title_full | Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis |
| title_fullStr | Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis |
| title_full_unstemmed | Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis |
| title_short | Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis |
| title_sort | cost effectiveness of selective digestive decontamination sdd versus selective oropharyngeal decontamination sod in intensive care units with low levels of antimicrobial resistance an individual patient data meta analysis |
| url | https://bmjopen.bmj.com/content/9/9/e028876.full |
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