Prophylaxis and cost effectiveness

Evidence continues to accumulate supporting the intracameral injection of antibiotics in order to prevent endophthalmitis following cataract surgery, according to Dr Ayman Naseri, speaking at the Endophthalmitis main symposia in Paris, France. "Despite the results of the ESCRS multi-centre clinical trial of intracameral cefuroxime,¹ still many surgeons do not use intracameral antibiotics. In the US, most surgeons prefer topical fluoroquinolone therapy.² Factors that may affect the surgeon's choice for antibiotic prophylaxis of endophthalmitis may include efficacy, safety, ease of application, medical/legal concerns, marketing and culture/education. Given the variance in antibiotic practice patterns, we elected to determine cost-effectiveness differences between commonly used antibiotic choices.

"We found that cost effectiveness of intracameral cefuroxime was $1403 (US 2007 dollars) per case of endophthalmitis prevented. By contrast, topical fluoroquinolones were less cost effective. The cost effectiveness of topical ciprofloxacin, moxifloxacin, and gatifloxacin were $6288, $18,474, and $19,527 respectively, even assuming that that these drugs were 100% effective. For a hypothetical cohort of 100,000 cases, the use of intracameral cefuroxime would lead to a cost savings of $480,000. By contrast, moxifloxacin and gatifloxacin use would cost over $4.5 million dollars to treat the same cohort.³"

In summary, intracameral cefuroxime is a highly cost-effective measure in the prevention of endophthalmitis. By contrast, topical fluoroquinolones are significantly less cost effective, even with optimistic assumptions regarding their efficacy.

References1.Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J. Cataract Refract. Surg. 2007 Jun;33(6):978-88.2.Chang DF, Braga-Mele R, Mamalis N, Masket S, Miller KM, Nichamin LD, et al. Prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J. Cataract Refract. Surg. 2007 Oct;33(10):1801-5. 3.Sharifi E, Porco T, Naseri A. Cost-Effectiveness analysis of intracameral cefuroxime use for prophylaxis of endophthalmitis following cataract surgery. Ophthalmology. 2009 Oct;116(10):1887-96.