Australian and New Zealand Journal of Obstetrics and Gynaecology 2008; 48: 592– 595 DOI: 10.1111/j.1479-828X.2008.00908.x 592 © 2008 The Authors Journal compilation © 2008 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Blackwell Publishing Ltd Original Article Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy Wei-Chun CHANG, 1,2 Meng-Chih LEE, 2 Lian-Shung YEH, 1 Yao-Ching HUNG, 1 Cheng-Chieh LIN 3,4 and Long-Yau LIN 2 1 Department of Obstetrics and Gynecology, China Medical University and Hospital, 2 Institute of Medicine, Chung-Shan Medical University, 3 Department of Family Medicine, China Medical University and Hospital, Taichung and 4 Institute of Health Care Administration, College of Health Science, Asia University, Taichung, Taiwan Background: An evidence-based initiation of quality improvement activity for reducing the usage of prophylactic antibiotic in laparoscopic-assisted vaginal hysterectomy (LAVH) in a tertiary hospital. Aims: The authors investigated whether single or multiple doses of cefazoline were more cost-effective in preventing postoperative infection associated with LAVH. Methods: The study groups comprised of 310 patients who had undergone LAVH continuously in a medical centre. Patients were divided into two groups on the basis of whether they received a single dose or multiple doses (range: two to four doses) of cefazoline during the perioperative period. Postoperative infections such as pelvic cellulitis or abscess, vaginal cuff abscess, wound infection and urinary tract infection that occurred either during hospitalisation or within one month after discharge were observed and recorded. Incremental cost-effectiveness ratio (ICER) was calculated using the mean direct drug cost and the prophylactic effect of infection in both groups. Results: The prophylactic effect of infection was similar in the single-dose group and the multiple-dose group (94.6% vs 93.9%, P = 0.986). The ICER was significantly lower in the single-dose group (153.3 vs 460.4, P < 0.001). Conclusions: The result revealed that a single dose of cefazoline is more cost-effective than multiple doses in the prevention of infection associated with LAVH. It fulfils the goal of cost minimisation and quality of care in today's environment of medical cost containment. Key words: antibiotics, hysterectomy, laparoscopic surgical procedure, vaginal. Current evidence-based clinical practice has put the major emphasis on establishing the cost-effectiveness of interventions. The shifting in the health-care system towards a more managed environment has forced health-care providers in a position to streamline resources and provide quality care in the most cost-effective way. Cost-effectiveness analysis (CEA) is analytical techniques in health care that may assist with more rational, effective and economically sound medical decision-making. 1–3 CEA, which assesses both the costs and the health outcomes of alternative health-care programs or strategies, can provide useful information about the relative benefits and trade-offs of different health-care interventions. The unit value of effectiveness in an incremental cost- effectiveness ratio (ICER) may be any unit such as quality- adjusted life years saved, a ratio of the difference in outcomes. If there is information on the outcome or effectiveness of two alternatives, and they are known to be equivalent, then the main interest is in identifying and choosing the least cost option, and this is called a cost-minimisation study. A clinical pathway for laparoscopic-assisted vaginal hysterectomy (LAVH) started at our hospital in January 1998, when medical expenditures were paid under the quota case–payment system. After a pilot study that proved a short course of combined prophylactic antibiotics (cephalothin + gentamycin) was as efficacious as a longer course in preventing postoperative infection, our department initiated a quality improvement activity for encouragement of further reducing prophylactic antibiotics usage in hospitalised LAVH patients since May 2000. 4 Previous studies have shown that the postoperative infection rate following LAVH is 2–5.6%. 5,6 In this study, a retrospective cohort study was conducted to prove the cost-minimisation result of a single dose versus multiple doses of single-agent prophylactic antibiotics to prevent postoperative infection in LAVH. Methods A cohort of 310 eligible patients who had undergone LAVH continuously in a medical centre in central Taiwan were studied. Patients were divided into two groups on the basis Correspondence: Dr Long-Yau Lin, Institute of Medicine, Chung-Shan Medical University, No. 110 Sec. 1, Chien-Kuo N. Road, Taichung 402, Taiwan. Email: wei66@iris.seed.net.tw Received 21 January 2008; accepted 16 June 2008.