Prophylactic antibiotics reduce C-section cost. (Given at Cord Clamp).

WASHINGTON -- Prophylactic antibiotic therapy during cesarean section reduces the cost of an uncomplicated elective procedure by about $30, Dr. David Chelmow reported in a poster session at the annual meeting of the Society for Gynecologic Investigation.

"There have been conflicting studies about the cost-effectiveness of prophylaxing these patients, but the bottom line is, unless infection becomes extremely rare, antibiotics become extremely expensive, or treating infection becomes extremely cheap, you will get some cost benefit with prophylactic antibiotics," Dr. Chelmow of Tufts-New England Medical Center, Boston, said in an interview.

He and his colleagues created a decision tree comparing the use of prophylactic antibiotic therapy in cesarean section (cefazolin 1 g IV at time of cord clamp) with no antibiotic use. The model included the cost of treating any anaphylaxis that might occur as well as that of treating fever and endometritis.

Treatment costs were 2001 estimates derived from the Tufts database and included costs for nurses, physicians, drugs, and materials.

Outcome probabilities and antibiotic effectiveness data were obtained from published metaanalyses.

The cost of an uncomplicated elective cesarean section was $1,638.57. Evaluation of fever added $125.91. Treatment of endometritis added $733. The cost of managing anaphylaxis was $482.74, but the risk of this was very low, at 0.02%. The cost of the single dose of cefazolin was $1.01. Factoring in these costs and the relative risks of each complication brought the adjusted price of a cesarean section to $1,683.72.

"Using these figures, prophylaxis reduced the cost to $1,653.06, a savings of $30.66," Dr. Chelmow said.