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Published on: September 15, 2023
Sternal-Wound Infections following Coronary Artery Bypass Graft: Could Implementing Value-Based Purchasing be
Dominique Brandt1, Maximilian Blüher2, Julie Lankiewicz3
1Health Economics & Clinical Outcomes Research, Xavier University, Cincinnati, OH, USA.
Insights
Sternal-wound infections (SWIs) after coronary artery bypass graft surgery (CABG) incur significant costs globally. Addressing SWIs can reduce healthcare burdens and improve patient outcomes, potentially through value-based purchasing.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Health Economics
Background:
- Sternal-wound infections (SWIs) are rare but serious complications following coronary artery bypass graft (CABG) surgery.
- The economic impact of SWIs on healthcare systems is not well-understood.
- This study quantifies the burden of SWIs in mature healthcare systems.
Purpose of the Study:
- To quantify the economic and care burden of SWIs after CABG surgery across 14 countries.
- To estimate potential value-based purchasing (VBP) levels based on the local burden of SWIs.
- To calculate the feasible cost of interventions to reduce SWI rates.
Main Methods:
- A structured literature review identified data from 14 countries.
- A Markov model simulated the CABG care pathway to estimate SWI costs and burden.
- Value-based purchasing scenarios and intervention costs for SWI reduction were explored.
Main Results:
- SWI rates varied from 2.8% in the UK to 10.4% in the Netherlands.
- Costs per SWI ranged from $8,172 in Brazil to $54,180 in Japan, with extended length of stay being the main cost driver.
- The highest annual burden was in the US ($336 million), with a median intervention cost per patient ranging from $20 in France to $111 in Japan.
Conclusions:
- SWIs represent a substantial burden, costing a median of $13,995 per case and $900 per CABG procedure.
- Reducing SWIs can decrease healthcare system burden and improve patient outcomes.
- Value-based purchasing agreements could incentivize novel SWI prevention methods.
Background/Objectives:
Sternal-wound infections (SWIs) are rare but consequential healthcare-healthcare-associated infections following coronary artery bypass graft surgery (CABG). The impact of SWIs associated on the cost of health care provision is unknown. The aim of this study was to quantify the burden of CABG-related SWIs across countries with mature health care systems and estimate value-based purchasing (VBP) levels based on the local burden.
Methods:
A structured literature review identified relevant data for 14 countries (the Netherlands, France, Germany, Austria, the United Kingdom, Canada, Italy, Japan, Spain, the United States, Brazil, Israel, Taiwan, and Thailand). Data, including SWI rates, CABG volume, and length of stay, were used to populate a previously published Markov model that simulates the patient's CABG-care pathway and estimates the economic (US$) and care burden of SWIs for each country. Based on this burden, scenarios for VBP were explored for each country. A feasible cost of intervention per patient for an intervention providing a 20% reduction in the SWI rate was calculated.
Results:
The SWI burden varied considerably between settings, with SWIs occurring in 2.8% (the United Kingdom) to 10.4% (the Netherlands) of CABG procedures, while the costs per SWI varied between US$8172 (Brazil) to US$54 180 (Japan). Additional length of stay after SWI was the largest cost driver. The overall highest annual burden was identified in the United States (US$336 million) at a mean cost of US$36 769 per SWI. Given the SWI burden, the median cost of intervention per patient that a hospital could afford ranged from US$20 (US$13 to US$42) in France to US$111 (US$65 to US$183) in Japan.
Conclusions:
SWIs represent a large burden with a median cost of US$13 995 per case and US$900 per CABG procedure. By tackling SWIs, there is potential to simultaneously reduce the burden on health care systems and improve outcomes for patients. Mutually beneficial VBP agreements might be one method to promote uptake of novel methods of SWI prevention.
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