Cost–benefit analysis of surveillance for surgical site infection following caesarean section

Wloch, Catherine, van Hoek, Albert Jan, Green, Nathan, Conneely, Joanna, Harrington, Pauline, Sheridan, Elizabeth, Wilson, Jennie ORCID: https://orcid.org/0000-0002-4713-9662 and Lamagni, Theresa (2020) Cost–benefit analysis of surveillance for surgical site infection following caesarean section. BMJ Open, 10 (7).

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Abstract

Objective To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme.
Design Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers’ perspective.
Setting England.
Participants Women undergoing caesarean section in National Health Service
hospitals.
Main outcome measure Costs attributable to treatment and management of surgical site infection following caesarean section.
Results The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18,914 (95% CI 11,521 to 29,499) with 28% accounted for by community care (£5,370). With inflation to 2019 prices, this equates to an estimated cost of £5.0m for all caesarean sections performed annually in England 2018-19, approximately £1,866 and £93 per infection managed in hospital and community respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3,747 (2010 costs).
Modelling a decrease in risk of infection of 30, 20 or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance
when the baseline risk of infection was 10 or 15% and smaller loses with a baseline risk of 5%.
Conclusion Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.
Strengths and limitations
• The model estimated both community (28%) and hospital costs (72%), providing a more representative estimate of overall economic burden to the health service.
• Time-matching of patients with and without infection according to length of post-operative stay provided a more accurate assessment of excess bed-days attributable to surgical site infection (2.6 days) than average excess length of stay (median difference 5 days) comparison by disentangling the impact of prolonged length of stay on increased chance of detecting an infection.
• Through capture and assessment of the costs and impact of surveillance, our model demonstrated the potential for savings through reductions in incidence of surgical site infections.
• Costs were obtained from NHS National Schedule Reference Costs and other sources rather than observed expenditure and assumptions made about the number of extra midwife and general practitioner appointments resulting from infection.
• The study was based on healthcare utilisation and did not assess direct and indirect costs borne by the patients or their carers.

Item Type: Article
Subjects: Medicine and health
Related URLs:
Depositing User: Jisc Router
Date Deposited: 01 Jul 2020 14:01
Last Modified: 23 Jul 2020 12:46
URI: http://repository.uwl.ac.uk/id/eprint/7079

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