World J. Surg. 14, 277, 1990
World Journal of Surgery 9 1990 by the Soci6t6 Internationale de Chirurgie
Letter to the Editor
To the Editor Drug cost is frequently based on acquisition cost, as mentioned by Dr. Gay in his commentary to our article (Soteriou, M., Recker, F., Geroulanos, S., Turina, M.: Perioperative antibiotic prophylaxis in cardiovascular surgery: A prospective randomized comparative trial of cefazolin versus ceftriaxone. World J. Surg. 13:798, 1989), however, relatively inexpensive drugs may be costly to use, whereas more expensive drugs may have lower global costs. A drug cost based on acquisition price alone may not be an accurate reflection of the true costs of antibiotic prophylaxis. In addition to the acquisition cost, material, preparation, and administrative costs as well as laboratory and complication costs have to be taken into consideration. Our study has clearly shown that cefazolin and ceftriaxone are comparable concerning complication rate, hospitalization time, and lethality. There is, therefore, no difference in complications, hospitalization, or in litigation cost. The same is true for laboratory costs. Neither cefazolin nor ceftriaxone need any plasma level monitoring (whereas aminoglycosides do). However, preparation and administrative costs differ markedly between the 2 drugs. Preparation and administrative costs include material such as syringes, needles, saline, etc.; ex-
penses for nursing and administrative time; as well as transportation and elimination costs. These are calculated to be between $3 and $5 per dose in the United States of America (Dr. H.E. Gladen, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.). In Zurich, these costs are calculated to be SFr. 6.20 (approximately 3.9 US$). By reducing our prophylaxis from a 4-day cefazolin treatment (16 doses) to a 2-day cefuroxime treatment (4 doses) and from a 2-day cefuroxime prophylaxis, finally, to a single-dose prophylaxis, more than 1 million Swiss Francs were saved over the last 6 years [1]. Reference
1. Geroulanos, S., Soteriou, M., Jemec, M., Meili, S., Turina, M.: Cost saving single shot prophylaxis in cardiovascular surgery. South Afr. J. Surg. (in press) Stefanos Geroulanos, M.D., Ph.D. Department of Surgery University Hospital Zurich, Switzerland
World Journal of Surgery 9 1990 by the Soci6t6 Internationale de Chirurgie
Letter to the Editor
To the Editor Drug cost is frequently based on acquisition cost, as mentioned by Dr. Gay in his commentary to our article (Soteriou, M., Recker, F., Geroulanos, S., Turina, M.: Perioperative antibiotic prophylaxis in cardiovascular surgery: A prospective randomized comparative trial of cefazolin versus ceftriaxone. World J. Surg. 13:798, 1989), however, relatively inexpensive drugs may be costly to use, whereas more expensive drugs may have lower global costs. A drug cost based on acquisition price alone may not be an accurate reflection of the true costs of antibiotic prophylaxis. In addition to the acquisition cost, material, preparation, and administrative costs as well as laboratory and complication costs have to be taken into consideration. Our study has clearly shown that cefazolin and ceftriaxone are comparable concerning complication rate, hospitalization time, and lethality. There is, therefore, no difference in complications, hospitalization, or in litigation cost. The same is true for laboratory costs. Neither cefazolin nor ceftriaxone need any plasma level monitoring (whereas aminoglycosides do). However, preparation and administrative costs differ markedly between the 2 drugs. Preparation and administrative costs include material such as syringes, needles, saline, etc.; ex-
penses for nursing and administrative time; as well as transportation and elimination costs. These are calculated to be between $3 and $5 per dose in the United States of America (Dr. H.E. Gladen, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.). In Zurich, these costs are calculated to be SFr. 6.20 (approximately 3.9 US$). By reducing our prophylaxis from a 4-day cefazolin treatment (16 doses) to a 2-day cefuroxime treatment (4 doses) and from a 2-day cefuroxime prophylaxis, finally, to a single-dose prophylaxis, more than 1 million Swiss Francs were saved over the last 6 years [1]. Reference
1. Geroulanos, S., Soteriou, M., Jemec, M., Meili, S., Turina, M.: Cost saving single shot prophylaxis in cardiovascular surgery. South Afr. J. Surg. (in press) Stefanos Geroulanos, M.D., Ph.D. Department of Surgery University Hospital Zurich, Switzerland
