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

• Published in: BMJ open Vol. 10; no. 7; p. e036919
• Main Authors: Wloch, Catherine, Van Hoek, Albert Jan, Green, Nathan, Conneely, Joanna, Harrington, Pauline, Sheridan, Elizabeth, Wilson, Jennie, Lamagni, Theresa
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 20-07-2020; BMJ Publishing Group
• Series: Original research
• Subjects: Antibiotics; Cesarean section; Cesarean Section - adverse effects; Cost benefit analysis; Cost control; England - epidemiology; Epidemiology; Female; Health Economics; Health services; Health surveillance; Humans; Infections; Methods; Midwifery; Patients; Pregnancy; Public health; State Medicine; Surgical site infections; Surgical Wound Infection - epidemiology; England; United Kingdom > UK; epidemiology; maternal medicine; health economics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-036919

ObjectiveTo 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.DesignEconomic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers’ perspective.SettingEngland.ParticipantsWomen undergoing caesarean section in National Health Service hospitals.Main outcome measureCosts attributable to treatment and management of surgical site infection following caesarean section.ResultsThe 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 (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018–2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (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%.ConclusionSurveillance 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.