Cost analysis of antibiotic prophylaxis for PEG

Background: There are conflicting recommendations regarding the prophylacti c use of antibiotics in patients undergoing placement of percutaneous endos copic gastrostomy tubes. The purpose of this decision analysis was to asses s the cost-effectiveness of antibiotic prophylaxis in percutaneous endoscop ic gastrostomy, Methods: A decision tree was modeled using the data of 7 published prospect ive placebo-controlled trials. Infectious complications were classified as grade I (requiring local care), grade II (requiring intravenous antibiotics ), or grade III (requiring surgery), Medication costs were estimated from t he United States average wholesale prices of the 1998 Red Book. Physician a nd facility costs were estimated based on the 1998 Medicare costs, A one-wa y sensitivity analysis was performed by varying the probability rates of th e complications associated with percutaneous endoscopic gastrostomy and the costs of their treatment. Results The average cost of prophylactic antibiotics was $13.10, Antibiotic prophylaxis led to expected cost savings of $76.72 per percutaneous endosc opic gastrostomy, A sensitivity analysis suggested that antibiotic prophyla xis for percutaneous endoscopic gastrostomy was the preferred strategy unle ss the average probability of grade III complications dropped below an impr obably low threshold value of 0.09%, Conclusion: Antibiotic prophylaxis in percutaneous endoscopic gastrostomy i s a cost-effective strategy.