Prophylactic antibiotics with operative vaginal delivery: a cost-utility
analysis based on the ANODE trial.
Abstract
Objective To perform a cost utility analysis of prophylactic antibiotics
compared with a placebo in preventing maternal infection after operative
vaginal birth. Design Economic analysis based on the findings of the
ANODE trial, a multi-centre randomised placebo‐controlled trial. Setting
Twenty-seven hospital obstetric units across the UK. Population or
Sample Women who underwent operative vaginal delivery after at least 36
weeks of gestation. Methods A cost utility analysis from the perspective
of the National Health Service was performed. To inform the decision
analysis, a decision tree was constructed to calculate an incremental
cost effectiveness ratio (ICER). Two one-way sensitivity analyses were
conducted. Main Outcome Measures Difference in quality of life and cost
between patients given the antibiotics and the placebo. Quality of life
scores were reported EQ-5D-5L measurements from the ANODE trial. Results
The ANODE trial reported a statistically significant reduction in
infection rates with the co-amoxiclav intervention, this was found to
yield an improvement of 0.017 QALYs over the placebo1. The cost to the
NHS of the intervention was also lower at £120 over 6 weeks compared to
the placebo’s £194. This gives an ICER of -£4403.14/QALY. Sensitivity
analysis confirmed that the intervention was dominant. Conclusions A
prophylactic dose of co-amoxiclav following operative vaginal delivery
is a cost-effective intervention, offering improved QoL whilst also
reducing overall costs over a 6-week time period. Tweetable abstract
Prophylactic antibiotics are a cost-effective way to reduce maternal
infection after operative vaginal delivery.