Cost Effectiveness of Rectal Culture-based Antibiotic Prophylaxis in Transrectal Prostate Biopsy: The Results from a Randomized, Nonblinded, Multicenter Trial

• Published in: European urology open science (Online) Vol. 50; pp. 70 - 77
• Main Authors: Tops, Sofie C.M., Kolwijck, Eva, Koldewijn, Evert L., Somford, Diederik M., Delaere, Filip J.M., van Leeuwen, Menno A., Breeuwsma, Anthonius J., de Vocht, Thijn F., Broos, Hans J.H.P., Schipper, Rob A., Steffens, Martijn G., Wegdam-Blans, Marjolijn C.A., de Brauwer, Els, van den Bijllaardt, Wouter, Leenders, Alexander C.A.P., Sedelaar, J.P. Michiel, Wertheim, Heiman F.L., Adang, Eddy
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2023; Elsevier
• Subjects: Cost effectiveness; Culture-based antibiotic prophylaxis; Empirical antibiotic prophylaxis; Infectious complications; Prostate Cancer; Transrectal prostate biopsy; Infectious complications; Transrectal prostate biopsy; Culture-based antibiotic prophylaxis; Empirical antibiotic prophylaxis; Cost effectiveness
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2023.02.006

From a societal perspective, the efficiency of rectal culture-based prophylaxis was comparable with that of empirical ciprofloxacin prophylaxis. From a healthcare perspective, rectal culture-based prophylaxis was more expensive than empirical prophylaxis at slightly, though insignificantly, better quality of life. Our results should be interpreted in the context of local ciprofloxacin resistance rates and healthcare costs, which can be reduced when optimizing our rectal culture protocol. Culture-based antibiotic prophylaxis is a plausible strategy to reduce infections after transrectal prostate biopsy (PB) related to fluoroquinolone-resistant pathogens. To assess the cost effectiveness of rectal culture-based prophylaxis compared with empirical ciprofloxacin prophylaxis. The study was performed alongside a trial in 11 Dutch hospitals investigating the effectiveness of culture-based prophylaxis in transrectal PB between April 2018 and July 2021 (trial registration number: NCT03228108). Patients were 1:1 randomized for empirical ciprofloxacin prophylaxis (oral) or culture-based prophylaxis. Costs for both prophylactic strategies were determined for two scenarios: (1) all infectious complications within 7 d after biopsy and (2) culture-proven Gram-negative infections within 30 d after biopsy. Differences in costs and effects (quality-adjusted life-years [QALYs]) were analyzed from a healthcare and societal perspective (including productivity losses, and travel and parking costs) using a bootstrap procedure presenting uncertainty surrounding the incremental cost-effectiveness ratio in a cost-effectiveness plane and acceptability curve. For the 7-d follow-up period, culture-based prophylaxis (n = 636) was €51.57 (95% confidence interval [CI] 6.52–96.63) more expensive from a healthcare perspective and €16.95 (95% CI –54.29 to 88.18) from a societal perspective than empirical ciprofloxacin prophylaxis (n = 652). Ciprofloxacin-resistant bacteria were detected in 15.4%. Extrapolating our data, from a healthcare perspective, 40% ciprofloxacin resistance would lead to equal cost for both strategies. Results were similar for the 30-d follow-up period. No significant differences in QALYs were observed. Our results should be interpreted in the context of local ciprofloxacin resistance rates. In our setting, from a healthcare perspective, culture-based prophylaxis was significantly more expensive than empirical ciprofloxacin prophylaxis. From a societal perspective, culture-based prophylaxis was somewhat more cost effective against the threshold value customary for the Netherlands (€80.000). Culture-based prophylaxis in transrectal prostate biopsy was not associated with reduced costs compared with empirical ciprofloxacin prophylaxis.