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ECONOMIC ASSESSMENT OF THE EFFECTIVENESS AND SAFETY OF THE COMMONLY PRACTICED PERIOPERATIVE ANTIBIOTIC PROPHYLAXIS (BASED ON AN EARLIER EPIDEMIOLOGICAL SURVEY OF MULTIDISCIPLINARY HOSPITALS)

https://doi.org/10.17749/2070-4909.2017.10.2.003-011

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Abstract

A survey conducted in four hospitals located in the city of St. Petersburg revealed that the commonly used perioperative antibiotic prophylaxis (PAP) did not follow (in 88% of cases) the guidelines approved for national clinical practice.

Aim. To perform a cost-effectiveness analysis of the commonly practiced PAP among patients with clean, clean-contaminated and contaminated surgical wounds in a multidisciplinary hospital.

Materials and methods. The PAP cost-effectiveness analysis was performed using the data from a multicenter epidemiological survey and previously conducted studies. The Markov model was used to compare the effectiveness and safety of the commonly used PAP with that recommended by the clinical practice guidelines. The rate of surgical site infection (SSI) and antibiotic-associated diarrhea (AAD) were chosen for the endpoints.

Results. The costs associated with a single case of PAP according to the clinical practice guidelines was 3.5 times less than that associated with the PAP used in the common practice (RUB 4913,67 and 17837,71 respectively). The present analysis demonstrates that the PAP recommended by the clinical practice guidelines was more cost-effective as compared with the commonly practiced PAP.

Conclusion. Regular epidemiological monitoring is required to improve effectiveness and safety of the existing PAP practice. 

About the Authors

Yu. M. Gomon
First Pavlov State Medical University, Health Ministry of Russian Federation; St. George City Hospital
Russian Federation

PhD, Assistant Professor, Department of clinical pharmacology and evidence-based medicine;

clinical pharmacologist,

ul. L. Tolstogo, 6-8, Saint-Petersburg, 197022



A. S. Kolbin
First Pavlov State Medical University, Health Ministry of Russian Federation; Saint-Petersburg State University
Russian Federation

MD, Professor, Head of Department of clinical pharmacology and evidence-based medicine, ul. L. Tolstogo, 6-8, Saint-Petersburg, 197022;

Professor, Department of Pharmakology, 21-Line, 8, VO, Saint-Petersburg, 199106



S. V. Sidorenko
Research Institute of Children’s Infections, Federal Medico-Biological Agency
Russian Federation

MD, Professor, Head of Department of molecular microbiology and epidemiology,

ul. Professora Popova, 9, Saint-Petersburg, 197022



A. M. Kuzhel’
Territorial Fund of Compulsory Medical Insurance
Russian Federation

Head,

ul. Koli Tomchaka, 9 A, Saint-Petersburg, 196084



A. V. Repina
Territorial Fund of Compulsory Medical Insurance
Russian Federation

Assistant Director,

ul. Koli Tomchaka, 9 A, Saint-Petersburg, 196084



Yu. V. Lobzin
Research Institute of Children’s Infections, Federal Medico-Biological Agency
Russian Federation

MD, Member of the Russian Academy of Science, Professor, Head,

ul. Professora Popova, 9, Saint-Petersburg, 197022



Yu. E. Balykina
Saint-Petersburg State University
Russian Federation

PhD, Associate Professor, Department of mathematic simulation,

Universitetskiy pr., 35, Peterhof, Saint-Petersburg, 198504



References

1. Naser N. R. Principles of optimization of empirical antibiotic therapy in patients with urgent surgical pathology in a multidisciplinary hospital. MD diss. [Printsipy optimizatsii empiricheskoi antibakterial’noi terapii bol’nykh s neotlozhnoi khirurgicheskoi patologiei v mnogoprofil’nom statsionare. Diss. … dokt. med. nauk. (in Russian)]. 2015.

2. Golub A. V., Kozlov R. S. Vrach. Spetsvypusk «Infektsionnye bolezni». 2015; 1: 4-9.

3. Sidorenko S. V., Kolbin A. S., Shlyapnikov S. A. Farmakoepidemiologicheskoe issledovanie ispol’zovaniya antibakterial’nykh sredstv v mnogoprofil’nom statsionare. Antibiot Khimioter. 2017; 5 (6).

4. Culver et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med. 1991; 91: (3B).

5. National Nosocomial Infections Surveillance (NNIS) System Report,data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control. 2003; 31: 481-498.

6. On approval of the branch standard “Clinico-economic studies. General provisions”. Order No. 163 Of The Ministry Of Health Of The Russian Federation of 27.05.2011 [Ob utverzhdenii otraslevogo standarta «Kliniko-ekonomicheskie issledovaniya Obshchie polozheniya». Prikaz №163 Ministerstva Zdravookhraneniya Rossiiskoi Federatsii ot 27.05.2011 (in Russian)].

7. Guidelines for the assessment of the impact of the budget in the framework of the program of State guarantees of free rendering to citizens of medical aid. FSBI “ZECKE” Ministry of health of Russia. Approved by order of the fgbi “ZECKE” Ministry of health of Russia from 23 December 2016 No 145-od. [Metodicheskie rekomendatsii po otsenke vliyaniya na byudzhet v ramkakh realizatsii programmy Gosudarstvennykh garantii besplatnogo okazaniya grazhdanam meditsinskoi pomoshchi. FGBU «TsEKKMP» Minzdrava Rossii. Utverzhdeny prikazom FGBU «TsEKKMP» Minzdrava Rossii ot «23» dekabrya 2016 g. No 145-od (in Russian)]. Moscow. 2016.

8. Methodological recommendations for comparative clinical and economic evaluation of a drug. FSBI “ZECKE” Ministry of health of Russia. Approved by order of the fgbi “ZECKE” Ministry of health of Russia from 23 December 2016 No 145-od. [Metodicheskie rekomendatsii po provedeniyu sravnitel’noi kliniko-ekonomicheskoi otsenki Lekarstvennogo preparata. FGBU «TsEKKMP» Minzdrava Rossii. Utverzhdeny prikazom FGBU «TsEKKMP» Minzdrava Rossii ot «23» dekabrya 2016 g. No 145-od (in Russian)]. Moscow. 2016.

9. Basic concepts in health technology assessment: method. allowance. Under. edited by A. S. Kolbin, S. K. Zyryanov, D. Yu. Belousov [Osnovnye ponyatiya v otsenke meditsinskikh tekhnologii: metod. posobie. Pod. red. A. S. Kolbina, S. K. Zyryanova, D.Yu. Belousova (in Russian)]. Moscow. 2013; 42 s.

10. Avksent’ev M. A., Gerasimov B. V., Sura M. V. Clinical and economic analysis (assessment of the choice of medical technologies and quality management of medical care). Under the General editorship of P. A. Vorobyov [Kliniko-ekonomicheskii analiz (otsenka vybor meditsinskikh tekhnologii i upravleniya kachestvom meditsinskoi pomoshchi). Pod obshch. red. P. A. Vorob’eva (in Russian)]. Moscow. 2004; 404 s.

11. Belousov Yu. B. Planning and conduct of clinical trials of medicines [Planirovanie i provedenie klinicheskikh issledovanii lekarstvennykh sredstv (in Russian)]. Moscow. 2000; 579 s.

12. Walley T., Haycox A., Boland A. Pharmacoeconomics. 2004; 216.

13. Federal clinical recommendations “the Principles of organization of perioperative antibiotic prophylaxis in health care”, MAKKAH, NAZCA, 2014. URL: http://nasci.ru/_resources/directory/198/common/2014_9_PAP_new.pdf/ (Accessed: 22.05.2017)

14. Carignan A., Allard C., Pépin J. et al. Risk of Clostridium difficile Infection after Perioperative Antibacterial Prophylaxis before and during an Outbreak of Infection due to a Hypervirulent Strain. Clinical Infectious Diseases. 2008; 46: 1838-43.

15. Vaishnavi C. Established and potential riskfactors for Clostridum difficile infection.Indian J Med Microbiol. 2009; 27 (4): 289-300.

16. Loo V. G., Poirier L., Miller M. A. et al. A predominantly clonal multiinstitutional outbreak of Clostridium difficile–associated diarrhea with high morbidity and mortality. N Engl J Med. 2005; 353: 2442-9.

17. Kreisel D., Savel T. G., Silver A. L. et al. Surgical antibiotic prophylaxis and Clostridium difficile toxin positivity. Arch Surg. 1995; 130: 989-993.

18. McDonald A. H., Cleland H. J., Leung M. et al. Slattery PG. Ring avulsion injuries. Aust N Z J Surg. 1999; 69: 514-6.

19. Castella A., Charrier L., Di Legami V. et al. Surgical site infection surveillance: analysis of adherence to recommendations for routine infection control practices. Infect Control Hosp Epidemiol. 2006; 27: 835-40.

20. Tourmousoglou C. E., Yiannakopoulou E. Ch., Kalapothaki V. et al. Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal. J Antimicrob Chemother. 2008; 61: 214-8.

21. Heineck I., Ferreira M. B., Schenkel E. P. Pescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil. Am J Infect Control. 1999; 27: 296-300.

22. Hosoglu S., Sunbul M., Erol S., et al. A national survey of surgical antibiotic prophylaxis in Turkey. Infect Control Hosp Epidemiol. 2003; 24: 758-61.

23. van Kasteren M. E., Manniën J., Ott A. et al. Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor. Clinical Infectious Diseases. 2007; 44: 921-7.

24. Chiara S. et al. Prolongation of antibiotic prophylaxis after clean and clean-contaminated surgery and surgical site infection. Minerva Anestesiologica. 2010; 76 (6): 413-19.

25. Klevens R. M. et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007; 122 (2): 160-6.

26. Price list for the provision of paid medical services, research institutes SP, 2017. URL: http://www.emergency.spb.ru/services/paid/328-price/ (Accessed: 22.05.2017).

27. The General tariff agreement, SPb, 2017. URL: http://www.spboms.ru/ (Accessed: 22.05.2017).

28. Federal law of 29.12.2006 N 255-FZ (as amended on 03.12.2011) “On compulsory social insurance against temporary disability and in connection with motherhood” URL: http://www.consultant.ru/document/cons_doc_LAW_64871/ (Accessed: 22.05.2017).

29. Federal state statistics service URL: http://www.gsk.ru/(Accessed: 22.05.2017).

30. The decree of the RF Government dated 04.12.2014 No. 1316 “On the limit value base for calculating insurance contributions to the social insurance Fund of the Russian Federation and the Pension Fund of the Russian Federation from January 01, 2015.” URL: http://www.consultant.ru/document/cons_doc_LAW_171922/ (Accessed: 22.05.2017).

31. Bedenkov A. V. Pharmacoepidemiological and pharmacoeconomic evaluation of perioperative DAD in abdominal surgery. PhD diss. [Farmakoepidemiologicheskaya i farmakoekonomicheskaya otsenka perioperatsionnoi PAP v abdominal’noi khirurgii. Diss. … kand. med. Nauk (in Russian)]. Moscow. 2005.

32. Pisarenko D. V. et al. Meditsinskii al’manakh. 2013; 2 (26): 191-194.

33. Eliseev A. V. et al. Kachestvennaya klinicheskaya praktika. 2016; 2: 24-28.

34. Coello R., Charlett A., Wilson J. et al. Adverse impact of surgical site infections in English hospitals. J Hosp Infect. 2005; 60 (2): 93-103.

35. Janks P. J. et al. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. The journal of hospital infection. Jan 2014; 86 (1): 24-33.

36. Whitehouse J. D. et al. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol. 2002; 23 (4):183-9.


For citation:


Gomon Y.M., Kolbin A.S., Sidorenko S.V., Kuzhel’ A.M., Repina A.V., Lobzin Y.V., Balykina Y.E. ECONOMIC ASSESSMENT OF THE EFFECTIVENESS AND SAFETY OF THE COMMONLY PRACTICED PERIOPERATIVE ANTIBIOTIC PROPHYLAXIS (BASED ON AN EARLIER EPIDEMIOLOGICAL SURVEY OF MULTIDISCIPLINARY HOSPITALS). FARMAKOEKONOMIKA. Modern Pharmacoeconomic and Pharmacoepidemiology. 2017;10(2):3-11. (In Russ.) https://doi.org/10.17749/2070-4909.2017.10.2.003-011

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