A Cost-Utility Analysis of Surgical Site Infection Prevention: Broadening the Scope

Surgical site infections (SSI) present a significant burden in terms of excess length of stay, distress, disability and death. SSI risk and the associated economic burden may be reduced through programmes of infection prevention and control (IPC) although evidence of their cost-effectiveness is limited. Patient-level data from the Evaluation of Cost of Nosocomial Infection (ECONI) study provided opportunity for analysis.

The aim of this study is to explore the cost-effectiveness of enhanced SSI prevention in terms of costs and quality of life for adult surgical patients in the UK National Health Service (NHS).

A Monte Carlo microsimulation model was built to evaluate the cost-effectiveness [cost per quality-adjusted life years (QALY)] of SSI prevention in three surgery types (coronary artery bypass graft, hip arthroplasty and caesarean section) by comparing an enhanced programme of SSI IPC to current clinical sequelae over 1 month and 1 year in the NHS. Uncertainty was explored through probabilistic sensitivity analysis, scenario analysis and the use of alternative utility valuation sets.

In most surgeries and time points, enhanced IPC was associated with lower costs and higher QALY gains than current SSI IPC measures. The results were sensitive to utility valuation methods used. Scenario analyses identified factors relating to SSI rate, IPC programme efficacy and cost resulted in strategy dominance changes over all three surgery types.

Enhanced programmes of IPC for SSIs may deliver improved health outcomes at a lower cost; however, this is not consistent across all surgery types and timepoints and is sensitive to various factors.