Cost effectiveness of selective decontamination of the digestive tract in liver transplant patients.

objectiveTo assess the cost effectiveness of selective decontamination of the digestive tract (SDD) in liver transplant patients.

designRandomised, placebo-controlled, double-blind trial with an integrated economic evaluation.

settingTwo university hospitals in The Netherlands. Cost effectiveness was assessed from a societal perspective. PATIENTS AND

participants58 patients who underwent liver transplantation and received SDD (n = 29) or placebo (n = 29) pre- and postoperatively.

interventionsSDD medication and placebo.

main outcome measuresInfection episodes, days of infection, costs of SDD and routine cultures, mean other direct medical costs per patient and additional costs of severe infection.

resultsCosts of SDD medicine and routine cultures were on average 3,100 US dollars ($US; 1997 values) per patient who underwent SDD. Both preoperatively and postoperatively, costs other than SDD and cultures did not significantly differ between the SDD and the placebo groups (preoperative, $US2,370 vs $US2,590; postoperative, $US25,455 vs $US24,915). Additional postoperative costs of severe infections were $US250 per day per patient. There were no significant differences in the mean number of infection episodes between groups.

conclusionsSDD leads to the additional costs of SDD medication and routine cultures, whereas no savings in other costs and no improvement in infection episodes are realised. Consequently, SDD may be considered as a nonefficient approach in patients undergoing liver transplantation. The additional costs of severe infection are considerable.