• Denise van Hout, Nienke L Plantinga, Patricia C Bruijning-Verhagen, OostdijkEvelien A NEANUniversity Utrecht, Utrecht, The Netherlands.Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., de SmetAnne Marie G AAMGAUniversity Utrecht, Utrecht, The Netherlands.Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands., G Ardine de Wit, BontenMarc J MMJMUniversity Utrecht, Utrecht, The Netherlands.Department of Medical Microbiology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands., and Cornelis H van Werkhoven.
• Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands D.vanHout-3@umcutrecht.nl.
• BMJ Open. 2019 Sep 6; 9 (9): e028876.

ObjectiveTo 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.DesignPost-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.Setting24 ICUs in the Netherlands.Participants12 952 ICU patients who were treated with ≥1 dose of SDD (n=6720) or SOD (n=6232).InterventionsSDD versus SOD.Primary And Secondary Outcome MeasuresThe 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.ResultsThe 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.ConclusionIn 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.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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