Grand Rounds

Does Azithromycin Cut Infection-associated Costs Following Cesarean Section?

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

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

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

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

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