Departments of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, the University of Wisconsin, Madison, Wisconsin, and Washington University in St. Louis, St. Louis, Missouri.
Obstet Gynecol. 2017 Dec;130(6):1279-1284. doi: 10.1097/AOG.0000000000002333.
To investigate the cost-effectiveness of adding azithromycin to standard cephalosporin regimens of cesarean delivery prophylaxis by considering the maternal outcomes in the current and potential subsequent pregnancies.
A cost-effectiveness model was created using TreeAge to compare the outcomes of using azithromycin-cephalosporin with cephalosporin alone in a theoretical cohort of 700,000 women, the approximate number of nonelective cesarean deliveries annually in the United States that occur during labor or after membrane rupture. Outcomes examined included endometritis, wound infection, sepsis, venous thromboembolism, and maternal death in the current pregnancy and uterine rupture, cesarean hysterectomy, and maternal death in subsequent pregnancies, including cost and quality-adjusted life-years for both pregnancies. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Sensitivity analyses were used to determine the robustness of our results.
Compared with cephalosporin alone for prophylaxis, our model showed 16,100 fewer cases of endometritis, 17 fewer cases of sepsis, eight fewer cases of venous thromboembolism, and one fewer maternal death with azithromycin-cephalosporin. Additionally, this strategy prevented 36 uterine ruptures and four cesarean hysterectomies in the subsequent pregnancy. Overall, the addition of azithromycin led to both lower costs and higher quality-adjusted life-years when compared with standard cephalosporin prophylaxis. In sensitivity analysis, we found that as long as the cost of azithromycin remained below $930 (baseline cost $27), it was cost-effective.
For women who undergo cesarean delivery in labor or after membrane rupture, compared with cephalosporin alone, the addition of azithromycin to cesarean delivery infection prophylaxis is less costly and leads to better maternal outcomes in the index delivery and subsequent deliveries. These findings support the use of prophylactic azithromycin at the time of cesarean delivery.
通过考虑当前和潜在后续妊娠中的母婴结局，研究在剖宫产预防性使用阿奇霉素加用头孢菌素方案的成本效益。
使用 TreeAge 创建了一个成本效益模型，以比较在一个理论上的 70 万女性队列中使用阿奇霉素-头孢菌素与单独使用头孢菌素的结果，这大约是美国每年在分娩或胎膜破裂后进行的非选择性剖宫产的数量。评估的结果包括当前妊娠中的子宫内膜炎、伤口感染、败血症、静脉血栓栓塞和孕产妇死亡，以及后续妊娠中的子宫破裂、剖宫产子宫切除术和孕产妇死亡，包括两个妊娠的成本和质量调整生命年。概率、效用和成本来自文献，成本效益阈值设定为每质量调整生命年 10 万美元。进行了敏感性分析以确定我们结果的稳健性。
与单独使用头孢菌素预防相比，我们的模型显示使用阿奇霉素-头孢菌素可减少 16100 例子宫内膜炎、17 例败血症、8 例静脉血栓栓塞和 1 例孕产妇死亡。此外，这种策略还预防了后续妊娠中的 36 例子宫破裂和 4 例剖宫产子宫切除术。总体而言，与标准头孢菌素预防相比，添加阿奇霉素可降低成本并提高质量调整生命年。在敏感性分析中，我们发现只要阿奇霉素的成本低于 930 美元（基线成本为 27 美元），它就是具有成本效益的。
对于在分娩或胎膜破裂后行剖宫产的女性，与单独使用头孢菌素相比，在剖宫产感染预防中添加阿奇霉素可降低成本，并在本次分娩和后续分娩中获得更好的母婴结局。这些发现支持在剖宫产时预防性使用阿奇霉素。
