Original title: A cost-effectiveness analysis of selective decontamination of the digestive tract in mechanically ventilated patients in the intensive care unit
Ashwani Kumar, Alamgir Kabir, John A Myburgh, Anthony Delaney +7 · September 2026
Critically ill patients on breathing machines often face serious gut infections. Doctors wondered if a gut-cleaning treatment called selective decontamination of the digestive tract, or SDD, saves lives and money. This method gives patients targeted antibiotics to wipe out harmful gut bacteria while leaving helpful ones alone. Researchers in Australia compared patients getting SDD along with standard hospital care against patients who got standard care alone. They tracked the health records of these patients over 24 months. The team found that SDD helped patients spend slightly less time on breathing machines and lowered their use of other antibiotics. However, it did not significantly improve survival over the 24 months. Most importantly, the treatment ended up costing substantially more money overall. Because it drove up medical bills without clearly saving more lives, researchers concluded that SDD is very unlikely to be worth the cost.
Imagine you're deciding whether to buy a more expensive brand of sunscreen for a beach trip. The cheap one works fine for most people, but the expensive one claims to prevent sunburn better. You check the results: both brands give about the same protection, but the expensive one costs a lot more. You calculate that for every extra day of sunburn avoided, you'd pay a huge amount. In this paper, the expensive brand is SDD, the cheap one is standard care, and the 'sunburn' is death. The researchers found that SDD costs an extra A$669,726 for each extra year of life gained, which is far more than the health system is willing to pay, so it's not a good deal.
For critically ill patients on ventilators, infections are a major risk. This study shows that a widely used preventive treatment, selective decontamination of the digestive tract, does not improve survival and costs more than standard care. Hospitals and health systems can use this evidence to decide whether the extra expense is worth it, especially for patients with brain injuries where the cost per life-year is lower.
The abstract does not specify the exact willingness-to-pay threshold used, nor does it detail the components of healthcare costs or the methods for linking administrative data. It also does not report quality-of-life outcomes, which are important for cost-effectiveness. The subgroup analysis for traumatic brain injury is exploratory and may not be powered for definitive conclusions.
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A cost-effectiveness analysis of selective decontamination of the digestive tract in mechanically ventilated patients in the intensive care unit — Ashwani Kumar, Alamgir Kabir, John A Myburgh et al. — Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine — doi:10.1016/j.ccrj.2026.100213
Abstract licence: CC BY
Explanation generated by Synthesis from the abstract — it is not the original paper.