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Emile Sharifi, Travis Porco, James Kinyoun, Ayman Naseri; A Cost and Cost-effective Equivalence Study of Post Intravitreal Injection Endophthalmitis Prophylaxis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5544.
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To evaluate the cost-effectiveness of povidone-iodine for post-intravitreal injection endophthalmitis prophylaxis.
A cost-effectiveness model was constructed on a cost per case of endophthalmitis prevented basis. The cost-equivalence portion of our model explored the cost which antibiotic prophylactic regimens achieved cost-effective equivalence with povidone-iodine. Where available, cost and efficacy data were obtained from the literature. The Red Book 2007 edition served as the source for medication costs. Efficacy was defined as absolute reduction in rate of infection from background rate of infection. Primary outcome measures were cost per case prevented, incremental cost-effectiveness, cost threshold to achieve cost-effective equivalence, and ratio indicating how many times less expensive antibiotic alternatives would have to be to achieve cost-effective equivalence. Sensitivity analysis evaluated alternative scenarios when there was uncertainty underlying the base assumptions.
The cost-effectiveness for povidone-iodine is $518 per case of endophthalmitis prevented. Assuming the fixed efficacy of our base case, the point where the antibiotics would achieve cost-effective equivalence with povidone-iodine is $5.29. The least costly fluoroquinolone, ciprofloxacin, and the most expensive fluroquinolone, gatifloxacin, would have to be 4.7 times and 10.9 times less costly, respectively, than their actual costs to achieve cost-effective equivalence with povidone-iodine. Povidone-iodine and sulfacetamide are cost-savings in the base case. All of the remaining antibiotic alternatives do not achieve cost-effective equivalence in the sensitivity analysis scenario where zero rate of endophthalmitis is attributed to the topical antibiotics.
Povidone-iodine is a cost-effective prophylactic for endophthalmitis after intravitreal injection. Topical antibiotic alternatives, due to their high costs, are not as cost-effective by comparison.
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