Economic evaluation of appropriate duration of antibiotic prophylaxis for prevention of neurosurgical infections in a middle-income country

Abstract

Preoperative antibiotic prophylaxis is one of the preventive measures for surgical site infections (SSIs). Very little data about the cost effectiveness of the appropriate duration of antibiotic prophylaxis in low- and middle-income countries are available. We aim to assess the cost effectiveness of the use of antibiotic prophylaxis for <24hours to prevent neurosurgical infections in a middle-income country, Turkey. A 1-year prospective study was performed between June 2012 and June 2013. During this study period patients were followed-up on for the development of SSI by means of hospital and postdischarge surveillance. Patients included in the study group received appropriate duration of antibiotic prophylaxis (<24hours), and the duration of prophylaxis was longer in the control group. The antibiotic costs per patient, including prophylaxis and treatment, were calculated. A total of 822 operations consisting of craniotomy (n=558), spinal fusion (n=220), and ventricular shunt (n=44) were included in the study. The study group included 488 (59.4%) patients who underwent operations with appropriate duration (<24 hours) of antibiotic prophylaxis. Prophylactic antibiotic cost per patient was significantly lower in the study group ($3.35 and $20.41, respectively). The SSI rates did not differ between the 2 groups: 3.5% (17/488) in the study group and 3.6 (12/822) in the control group (P>.05). This cost-analysis study demonstrates that prolonged antibiotic prophylaxis correlates with increased burden of cost, but it is not preventive for SSI.