Cost-utility analysis of azithromycin to assist in the prevention of acute cesarean section infection in a Chinese population

Abstract

Abstract OBJECTIVE The infection rate of cesarean delivery in China is 7 to 20 times higher than that of vaginal delivery, and the infection rate of nonelective cesarean delivery may be even higher. Therefore, this study aimed to conduct a cost-utility analysis of cefazolin combined with azithromycin versus cefazolin alone for the prevention of nonelective cesarean infection from a society-wide perspective in China, taking into account maternal outcomes of current cesarean deliveries as well as potential pregnancies. METHODS A decision tree model was constructed using TreeAge Pro 2022 to simulate the total cost and lifetime health outcomes of pregnant women in China under two infection prophylaxis regimens. Epidemiological, quality-of-life and cost parameters were obtained from various sources, including published literature, publicly available documents from the Fujian Provincial Bureau of Medical Security, data from www.yaozh.com, and information from the China Bureau of Statistics. The discount rate has been established at 5% annually. The acceptable cost-utility threshold was established at three times China's GDP per capita in 2022. RESULTS An analysis of 800,000 nonelective cesarean deliveries during labor or after rupture of membranes in China estimated that the use of cefazolin combined with azithromycin reduced the incidence of endometritis by 18,400 cases, wound infections by 33,500 cases, sepsis by 24 cases, prevented a rupture of the uterus by 342 cases, hysterectomy by 24 cases, and maternal deaths by 3 cases, compared to the use of cefazolin prophylaxis alone. The baseline analysis indicates that the combination of cefazolin and azithromycin resulted in an increase of 0.00157 quality-adjusted life years and a cost reduction of $769.14, making it the superior regimen. The results of the sensitivity analysis confirmed the robustness of the baseline analysis. Conclusion The prophylactic use of cefazolin combined with azithromycin may result in better cost-effectiveness and health outcomes than cefazolin alone for Chinese pregnant women undergoing nonelective cesarean delivery.