BACKGROUND AND PURPOSE:

• A recent study by Tita et al. (NEJM, 2016) demonstrated that one dose of azithromycin in addition to cephalosporin for unscheduled cesarean section reduces infection risk by 50%
• Harper et al. (2017, Obstetrics & Gynecology) compared costs associated with including an additional dose of azithromycin for unscheduled and scheduled cesarean deliveries

METHODS:

• A decision analytic model was created to compare cefazolin alone with azithromycin plus cefazolin
• Existing literature was used for analysis
• Costs of cesarean section and cefazolin were not incorporated into the model as they would appear in both arms and therefore cancel out in the analysis
• No RTCs available for adjunctive azithromycin in scheduled cesarean sections
• The outcome was cost per cesarean delivery from a health system perspective and not the individual patient

RESULTS:

• In unscheduled cesarean deliveries in low risk women, the use of adjunctive azithromycin resulted in savings of $360 per cesarean delivery (95% CI $155-451)
  • Expected costs were reduced from $695 to $335
• In scheduled cesarean deliveries, the use of adjunctive azithromycin resulted in savings of $143 per cesarean delivery (95% CI $98-157)
  • Expected costs were reduced from $254 to $111

CONCLUSION:

• Adjunctive azithromycin prophylaxis was cost-saving in both scheduled and unscheduled cesarean surgeries
• In the US, with approximately 1.2 million cesarean deliveries per year, a single dose of perioperative azithromycin could save over $300 million annually
• Data supports the use of azithromycin for unscheduled cesarean sections
• Data also supports the use of azithromycin for scheduled cesarean sections; additional studies are warranted

Learn More – Primary Sources:

Economic Evaluation of Adjunctive Azithromycin Prophylaxis for Cesarean Delivery

Related ObG Topics:

Azithromycin Prophylaxis to Reduce Infection Risk Post C-Section

What Risk Factors Increase Likelihood of C-Section Infection?

Can Evidence-Based Interventions Reduce C-section Complications?

What is the best skin prep to prevent C-section wound infections?