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A cost effective approach to surgical antibiotic prophylaxis.

https://arctichealth.org/en/permalink/ahliterature223292
Source
Can J Hosp Pharm. 1992 Aug;45(4):151-6
Publication Type
Article
Date
Aug-1992
Author
M M Pavan
D L Malyuk
Author Affiliation
Royal Columbian Hospital, New Westminster, British Columbia.
Source
Can J Hosp Pharm. 1992 Aug;45(4):151-6
Date
Aug-1992
Language
English
Publication Type
Article
Keywords
Appendectomy - adverse effects - economics
British Columbia
Cefazolin - economics - therapeutic use
Cefoxitin - economics - therapeutic use
Cost-Benefit Analysis
Drug Costs
Drug Therapy, Combination - economics - therapeutic use
Evaluation Studies as Topic
Hospital Bed Capacity, 500 and over
Humans
Interdepartmental Relations
Metronidazole - economics - therapeutic use
Pharmacy Service, Hospital - economics - statistics & numerical data
Premedication - economics
Questionnaires
Random Allocation
Research Design
Surgical Wound Infection - economics - prevention & control
Abstract
Cefoxitin has been the prophylactic antibiotic of choice for appendectomy and colorectal surgery at this institution. Recent information suggests that cefazolin and metronidazole given as a single intravenous preparation could be a cost-effective alternative to cefoxitin or cefotetan for surgical antimicrobial prophylaxis of uncomplicated appendectomies. This study was conducted to determine the efficacy, toxicity, and cost of the current antibiotic regimens used for prophylaxis of uncomplicated appendectomies, to evaluate the efficacy, toxicity and cost of the cefazolin plus metronidazole combination in uncomplicated appendectomies, and to facilitate a cooperative working relationship between the Departments of Pharmacy and General Surgery. Although the numbers involved were small, this study suggests that the cefazolin/metronidazole combination is cost-effective. It is suggested that research is warranted in evaluating combinations such as this as cost-effective alternatives to current therapy.
PubMed ID
10123058 View in PubMed
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Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.

https://arctichealth.org/en/permalink/ahliterature285317
Source
Br J Surg. 2017 Sep;104(10):1355-1361
Publication Type
Article
Date
Sep-2017
Author
S. Sippola
J. Grönroos
R. Tuominen
H. Paajanen
T. Rautio
P. Nordström
M. Aarnio
T. Rantanen
S. Hurme
P. Salminen
Source
Br J Surg. 2017 Sep;104(10):1355-1361
Date
Sep-2017
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Adult
Anti-Bacterial Agents - economics - therapeutic use
Appendectomy - economics
Appendicitis - drug therapy - surgery
Cost-Benefit Analysis
Finland
Humans
Length of Stay - economics
Levofloxacin - economics - therapeutic use
Metronidazole - economics - therapeutic use
Middle Aged
Recurrence
Sick Leave - economics
Treatment Outcome
Young Adult
beta-Lactams - economics - therapeutic use
Abstract
An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial.
The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012.
Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P
PubMed ID
28677879 View in PubMed
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Therapeutic interchange of cefazolin with metronidazole for cefoxitin.

https://arctichealth.org/en/permalink/ahliterature223366
Source
Am J Hosp Pharm. 1992 Aug;49(8):1946-50
Publication Type
Article
Date
Aug-1992
Author
G R Brown
A M Clarke
Author Affiliation
Department of Pharmacy, St. Paul's Hospital, Vancouver, British Columbia.
Source
Am J Hosp Pharm. 1992 Aug;49(8):1946-50
Date
Aug-1992
Language
English
Publication Type
Article
Keywords
British Columbia
Cefazolin - economics - therapeutic use
Cefoxitin - economics - therapeutic use
Cost Savings
Drug Combinations
Drug Costs
Humans
Metronidazole - economics - therapeutic use
Pharmacy Service, Hospital - economics
Program Evaluation
Therapeutic Equivalency
Abstract
The effects on patient outcome and drug therapy costs of a therapeutic interchange program using a cefazolin and metronidazole combination in place of cefoxitin were studied. A therapeutic interchange program was initiated in which the pharmacy department automatically replaced orders for cefoxitin with orders for a cefazolin and metronidazole combination. Data were compared for 100 consecutive patients who received cefoxitin before initiation of the program and the first 100 patients who received cefazolin and metronidazole as part of the program. The impact of the program on therapeutic efficacy, adverse effects associated with therapy, and drug therapy costs was assessed. The two patient groups were similar in age, gender, and white blood cell count. The failure rates for treatment or prophylaxis of infection did not significantly differ between the groups. Duration of therapy and incidence of adverse effects did not significantly differ between the groups. The average cost saving was +72 per patient for treatment with cefazolin and metronidazole instead of cefoxitin. A program for therapeutic interchange of cefazolin and metronidazole in place of cefoxitin demonstrated equivalent efficacy and adverse effects, as well as considerable cost savings.
PubMed ID
1442838 View in PubMed
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