Shapiro M, Schoenbaum S C, Tager I B, Muñoz A, Polk B F
JAMA. 1983 Mar 11;249(10):1290-4.
We performed a benefit-cost analysis of antimicrobial prophylaxis for hysterectomy using data from a randomized, placebo-controlled clinical trial of the efficacy of three doses of cefazolin sodium. The excess cost per patient with either operative site or urinary tract infection, or febrile morbidity diagnosed during hospitalization, was +1,777 for vaginal and +716 for abdominal hysterectomy. In patients undergoing vaginal hysterectomy, prophylactic cefazolin reduced in-hospital infectious morbidity from 52% to 23% (preventive fraction, 56%), resulting in an average net benefit of +492 per patient. In abdominal hysterectomy, cefazolin decreased in-hospital morbidity from 43% to 25% (preventive fraction, 42%), resulting in an average net savings of +102 per patient. These benefits would be eroded by use of newer, more expensive cephalosporins unless they were considerably more effective than cefazolin. The benefits also would be diminished by inappropriate prolongation of the duration of prophylaxis.
我们利用一项关于三种剂量头孢唑林钠疗效的随机、安慰剂对照临床试验的数据，对子宫切除术的抗菌预防措施进行了效益成本分析。对于在住院期间被诊断为手术部位感染、尿路感染或发热性疾病的每位患者，阴道子宫切除术的额外费用为1777美元，腹部子宫切除术为716美元。在接受阴道子宫切除术的患者中，预防性使用头孢唑林可将住院期间的感染发病率从52%降至23%（预防率为56%），每位患者的平均净效益为492美元。在腹部子宫切除术中，头孢唑林将住院发病率从43%降至25%（预防率为42%），每位患者平均净节省102美元。除非新型、更昂贵的头孢菌素比头孢唑林有效得多，否则这些益处将因使用它们而受到损害。预防时间的不适当延长也会减少这些益处。
