Economic Evaluation of the Addition of Vancomycin to Cefazolin Prophylaxis in Patients Undergoing Arthroplasty

Tran-Duy, A; Asbury, S; Spelman, T; Paterson, DL; Buising, KL; McDougall, C; Solomon, M; Crawford, R; Adie, S; Molnar, R; Mulford, J; Harris-Brown, T; Roney, J; de Steiger, R; Peel, TN; ASAP Trial Group

Author(s): Tran-Duy, A; Asbury, S; Spelman, T; Paterson, DL; Buising, KL; McDougall, C; Solomon, M; Crawford, R; Adie, S; Molnar, R; Mulford, J; Harris-Brown, T; Roney, J; de Steiger, R; Peel, TN; ASAP Trial Group;
Details: Publication Year 2026-07,Volume 44,Issue #7,Page 839-849
Journal Title: PharmacoEconomics
Publication Type: Research article
Abstract: INTRODUCTION: The addition of a glycopeptide antimicrobial to cephalosporin therapy has been reportedly adopted in practice to prevent surgical site infections (SSIs). We conducted an economic evaluation from the healthcare sector perspective to assess the cost-effectiveness of adding vancomycin to cefazolin prophylaxis in patients undergoing arthroplasty. METHODS: Data were collected over 180 days in a randomised controlled trial conducted at 11 hospitals in Australia, involving 2044 patients assigned to vancomycin and 2069 to placebo, both in addition to cefazolin. Health utilities were measured using EQ-5D-3L at baseline and 30 days, 90 days, and 180 days post-surgery. Healthcare costs (Australian dollars [AU$]; 2022 values) were estimated using Medicare claim data and hospital administrative records. Bootstrap was used to estimate means and 95% confidence intervals (CIs) of healthcare costs and quality-adjusted life years (QALYs). The net monetary benefit framework was used to construct a cost-effectiveness acceptability curve. RESULTS: Over 180 days, 96 SSIs occurred in the vancomycin group, and 79 in the placebo group. Mean QALYs were 0.392 (95% CI 0.389-0.395) in the vancomycin group and 0.394 (95% CI 0.391-0.397) in the placebo group. Mean total healthcare costs were AU$5184 (95% CI 4926-5480) in the vancomycin group and AU$5018 (95% CI 4772-5293) in the placebo group. Using willingness-to-pay and willingness-to-accept thresholds from AU$0 to AU$3,000,000, the probability of vancomycin being not cost-effective ranged from 0.79 to 0.87. CONCLUSIONS: Adding vancomycin to cephazolin prophylaxis in arthroplasty is most likely not cost-effective. Omitting vancomycin could lead to substantial annual savings for the healthcare sector without compromising health outcomes.
Publisher: Springer Nature
Keywords: Aged; Female; Humans; Male; *Anti-Bacterial Agents/economics/therapeutic use/administration & dosage; *Antibiotic Prophylaxis/economics/methods; *Arthroplasty/economics/methods/adverse effects; Australia; *Cefazolin/economics/administration & dosage/therapeutic use; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Drug Therapy, Combination; First Generation Cephalosporins/administration & dosage/economics/therapeutic use; Health Care Costs; Quality-Adjusted Life Years; *Surgical Wound Infection/prevention & control/economics; *Vancomycin/economics/administration & dosage/therapeutic use
Department(s): Health Services Research
Publisher's Version: https://doi.org/10.1007/s40273-026-01609-0
Open Access at Publisher's Site: https://doi.org/10.1007/s40273-026-01609-0
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-04-07 03:20:38

Last Modified: 2026-07-14 12:09:29