• Evelien A N Oostdijk, G A de Wit, Marina Bakker, Anne Marie G A de Smet, M J M Bonten, and Dutch SOD-SDD trialists group.
• Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
• BMJ Open. 2013 Jan 1;3(3).

ObjectiveTo determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs).DesignA post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20).Setting13 Dutch ICUs.ParticipantsPatients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990).InterventionsSDD or SOD.Primary And Secondary Outcome MeasuresEffects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation.ResultsTotal costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving.ConclusionsSDD and SOD were both effective and cost-saving in Dutch ICUs.

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