Spontaneous bacterial peritonitis cost-effectiveness of therapy

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Cost-Effectiveness of Therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

The use of prophylactic antibiotics to decrease the incidence of spontaneous bacterial peritonitis is a cost-saving strategy in patients with cirrhosis and ascites.

Cost-Effectiveness of Therapy

• Norfloxacin prophylaxis resulted in savings between $2216 and $8545 per patient per year, depending on the patient group studied.
• Trimethoprim-sulfamethoxazole prophylaxis resulted in savings between $2934 and $9251 per patient per year.
• Abdominal paracentesis with appropriate ascitic fluid analysis is probably the most rapid and cost-effective method of diagnosing the cause of ascites
• Regular infusions of albumin for treatment of new-onset or refractory ascites should be considered experimental until more studies demonstrate efficacy and cost-effectiveness.
• Intravenous ciprofloxacin followed by oral administration of this drug was found to be more cost-effective compared to intravenous ceftazidime in a randomized trial in patients who had not received quinolone prophylaxis.
• Selective intestinal decontamination with norfloxacin or trimethoprim/sulfamethoxazole in patients with prior spontaneous bacterial peritonitis (SBP) or low-protein ascitic fluid does appear to be cost-effective.