An economic analysis of norfloxacin prophylaxis against spontaneous bacterial peritonitis

Background/Aims/Methods: Spontaneous bacterial peritonitis (SBP) is a frequent complication of advanced liver disease and in high-risk patients, it is associated with a mean (per episode) mortality of 29% and a mean 1-year mortality of 82%. The 1-year recurrence rate of SBP can be as high as 30-70%. Selective intestinal decontamination with antibiotic prophylaxis has been shown to significantly reduce the incidence of recurrent SBP. The aim of this study was to perform an economic analysis of norfloxacin prophylaxis to prevent SBP recurrence. Results: This analysis showed that norfloxacin prophylaxis in high-risk patients with cirrhosis resulted in USD 4632 savings per patient per year by avoiding SBP and its associated expense. A sensitivity analysis showed that the norfloxacin prophylaxis remained cost-saving, even if it resulted in only a modest reduction in the SBP recurrence rate. Conclusions: Selective gut decontamination with norfloxacin is not only efficacious in preventing SBP, but can also be cost-saving by avoiding the resource utilization associated with its treatment.