Cost-effectiveness of selective digestive decontamination (SDD) versus selective oropharyngeal decontamination (SOD) in intensive care units with low levels of antimicrobial resistance: an individual patient data meta-analysis

Denise van Hout*, Nienke L. Plantinga, Patricia C. Bruijning-Verhagen, Evelien A. N. Oostdijk, Anne Marie G. A. de Smet, G. Ardine de Wit, Marc J. M. Bonten, Cornelis H. van Werkhoven

*Corresponding author for this work

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Objective To 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.

Design Post-hoc analysis of a previously performed individual patient data meta-analysis of two cluster-randomised cross-over trials.

Setting 24 ICUs in the Netherlands.

Participants 12952 ICU patients who were treated with >= 1dose of SDD (n=6720) or SOD (n=6232).

Interventions SDD versus SOD.

Primary and secondary outcome measures The 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.

Results The 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 (sic)62 in favour of SDD, 95%CI -(sic)1079 to Euro935). Thus, SDD yielded significantly lower in-hospital mortality and comparable costs as compared with SOD. At a willingness-to-pay value of (sic)33633 per one prevented in-hospital death, SDD had a probability of 90.0% to be cost-effective as compared with SOD.

Conclusion In 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.

Original languageEnglish
Article number028876
Number of pages9
JournalBMJ Open
Issue number9
Publication statusPublished - Sep-2019
Externally publishedYes


  • cost-effectiveness
  • individual patient data meta-analysis
  • selective digestive decontamination
  • selective oropharyngeal decontamination
  • intensive care medicine
  • RISK

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