Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

NIHR Global Health Research Unit on Global Surgery, GlobalSurg Collaborative, NIHR Global Health Research Unit on Global Surgery Writing committee, GlobalSurg Collaborative writing group, GlobalSurg Collaborative patient representatives, Protocol development, GlobalSurg Collaborative national leads, GlobalSurg Collaborative protocol translators

Research output: Contribution to journalArticlepeer-review

Abstract

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Original languageEnglish
Article number100207
JournalBJA Open
Volume7
DOIs
StatePublished - Sep 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 The Authors

Keywords

  • abdominal surgery
  • cost-effectiveness analysis
  • global surgery
  • high fraction of inspired oxygen
  • low-and middle-income countries
  • surgical site infection

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