Cost‐effectiveness of standard vs intensive antibiotic regimens for transrectal ultrasonography (TRUS)‐guided prostate biopsy prophylaxis

Study Type – Diagnostic (cost effectiveness analysis) Level of Evidence 3a What's known on the subject? and What does the study add? Multiple studies have shown an increase in the hospital admission rates due to infectious complications after transrectal ultrasonography (TRUS) ‐guided prostate biopsy (TRUSBx), mostly related to a rise in the prevalence of fluoroquinolone‐resistant organisms. As a result, multiple series have advocated the use of more intensive prophylactic antibiotic regimens to augment the effect of the widely used fluoroquinolone prophylaxis for TRUSBx. The present study compares the cost‐effectiveness fluoroquinolone prophylaxis to more intensive prophylactic antibiotic regimens, which is an important consideration for any antibiotic regimen used on a wide‐scale for TRUSBx prophylaxis. OBJECTIVE To compare the cost‐effectiveness of fluoroquinolones vs intensive antibiotic regimens for transrectal ultrasonography (TRUS) ‐guided prostate biopsy (TRUSBx) prophylaxis. PATIENTS AND METHODS Risk of hospital admission for infectious complications after TRUSBx was determined from published data. The average cost of hospital admission due to post‐biopsy infection was determined from patients admitted to our University hospital ≤1 week of TRUSBx. A decision tree analysis was created to compare cost‐effectiveness of standard vs intensive antibiotic prophylactic regimens based on varying risk of infection, cost, and effectiveness of the intensive antibiotic regimen. RESULTS Baseline assumption included cost of TRUSBx (559), admission rate (1%), average cost of admission (5900) and cost of standard and intensive antibiotic regimens of 1 and 33, respectively. Assuming a 50% risk reduction in admission rates with intensive antibiotics, the standard regimen was slightly less costly with average cost of 619 vs 622, but was associated with twice as many infections. Sensitivity analyses found that a 1. 1% risk of admission for quinolone‐resistant infections or a 54% risk reduction attributed to the more intensive antibiotic regimen will result in cost‐equivalence for the two regimens. Three‐way sensitivity analyses showed that small increases in probability of admission using the standard antibiotics or greater risk reduction using the intensive regimen result in the intensive prophylactic regimen becoming substantially more cost‐effectiveness even at higher costs. CONCLUSION As the risk of admission for infectious complications due to TRUSBx increases, use of an intensive prophylactic antibiotic regimen becomes significantly more cost‐effective than current standard antibiotic prophylaxis.