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Grand Rounds

Does Azithromycin Cut Infection-associated Costs Following Cesarean Section?

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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

 

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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?

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