Background

Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI.

Methods

A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. The economic analysis used a partially split single-country costing approach, with pooled outcomes data from all seven countries in the ChEETAh trial, and data for resource use and unit costs from India (KIWI); secondary analyses used resource use and costs from Mexico and Ghana (KIWI).

Findings

In the base case, the average cost of the intervention was $259∙92 compared with $261∙10 for current practice (cost difference –$1∙18, 95% CI –4∙08 to 1∙33). In the intervention group, an estimated 17∙6% of patients had an SSI compared with 19∙7% of patients in the current practice group (absolute risk reduction 2∙10%, 95% CI 2∙07–2∙84). At all cost-effectiveness thresholds assumed ($0 to $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana.

Interpretation

Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs.

Funding

National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.

中文翻译：

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腹部伤口闭合时常规更换无菌手套和器械以防止手术部位感染 (ChEETAh)：对七个低收入和中等收入国家进行的一项实用整群随机试验进行的基​​于模型的成本效益分析

背景

手术部位感染（SSI）是患者和卫生系统的主要负担。本研究评估了在腹壁闭合前定期更换无菌手套和器械以预防 SSI 的成本效益。

方法

建立了决策分析模型，以与当前实践相比，估计腹壁闭合前更换手套和器械的平均成本和结果。临床数据来自 ChEETAh 试验，这是一项在七个低收入和中等收入国家 (LMIC) 进行的多中心、整群随机试验，成本来自一项评估 LMIC 中 SSI 相关成本的研究 (KIWI)。结果以导致 SSI 的手术百分比来衡量。成本是从医疗保健提供者的角度衡量的，并以 2021 年美元报告。经济分析采用部分分割的单一国家成本计算方法，汇总了 ChEETAh 试验中所有七个国家的结果数据，以及印度 (KIWI) 的资源使用和单位成本数据；二次分析使用了墨西哥和加纳 (KIWI) 的资源使用和成本。

发现

在基本案例中，干预的平均成本为 259∙92 美元，而当前做法的平均成本为 261∙10 美元（成本差异 – 1∙18 美元，95% CI –4∙08 至 1∙33）。在干预组中，估计有 17∙6% 的患者患有 SSI，而当前实践组中这一比例为 19∙7%（绝对风险降低 2∙10%，95% CI 2∙07–2∙84）。在所有假设的成本效益阈值（0 至 14 000 美元）下，与当前做法相比，干预措施具有成本效益的可能性更高，表明干预措施具有成本效益。当使用墨西哥和加纳的资源利用和单位成本数据重复使用印度数据进行分析时，得到了类似的结果。

解释

在腹壁闭合之前常规更换无菌手套和器械是有效的，并且成本与当前实践相似。中低收入国家应在腹壁闭合前例行更换手套和器械。

资金

美国国家健康与护理研究所 (NIHR) 临床科学家奖、NIHR 全球健康研究单位补助金和 Mölnlycke Healthcare。