TY - JOUR
T1 - Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh)
T2 - a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries
AU - NIHR Global Health Research Unit on Global Surgery
AU - Bywater, Edward
AU - Martinez, Laura
AU - Habumuremyi, Sosthene
AU - Ntirenganya, Faustin
AU - Williams, Emmanuel
AU - Tabiri, Stephen
AU - Fourtounas, Maria
AU - Ademuyiwa, Adesoji O.
AU - Melic, Bokossa K.Covalic
AU - Ghosh, Dhruv N.
AU - Suroy, Atul
AU - Ahogni, Didier
AU - Ahounou, Aristide
AU - Boukari, K. Alassan
AU - Gbehade, Oswald
AU - Hessou, Thierry K.
AU - Nindopa, Sinama
AU - Nontonwanou, M. J.Bienvenue
AU - Guessou, Nafissatou Orou
AU - Sambo, Arouna
AU - Tchati, Sorekou Victoire
AU - Tchogo, Affisatou
AU - Tobome, Semevo Romaric
AU - Yanto, Parfait
AU - Gandaho, Isidore
AU - Hadonou, Armel
AU - Hinvo, Simplice
AU - Hodonou, Montcho Adrien
AU - Tamou, Sambo Bio
AU - Lawani, Souliath
AU - Dossou, Francis Moise
AU - Gaou, Antoine
AU - Goudou, Roland
AU - Kouroumta, Marie Claire
AU - Lawani, Ismail
AU - Malade, Enrif
AU - Dikao, Anne stredy Mkoh
AU - Nsilu, Joel Nzuwa
AU - Ogouyemi, Pencome
AU - Akpla, Marcelin
AU - Mitima, Nathan Bisimwa
AU - Kovohouande, Blaise
AU - Loupeda, Stephane Laurent
AU - Agbangla, Mamonde Victorin
AU - Hedefoun, Sena Emmanuel
AU - Adu-Aryee, Nii A.
AU - Bediako-Bowan, Antoinette A.
AU - Dedey, Florence
AU - Nsaful, Josephine
AU - Mumuni, Kareem
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/2
Y1 - 2024/2
N2 - 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 $14 000), the intervention had a higher likelihood of being cost-effective compared with current practice, indicating that the intervention was cost-effective. Similar results were obtained when the analysis using data from India was repeated using resource use and unit cost data from Mexico and Ghana. Interpretation: Routine sterile glove and instrument change before abdominal wall closure is effective and the costs are similar to those for current practice. Routine change of gloves and instruments before abdominal wall closure should be rolled out in LMICs. Funding: National Institute for Health and Care Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, and Mölnlycke Healthcare.
AB - Background: Surgical site infection (SSI) is a major burden on patients and health systems. This study assessed the cost-effectiveness of routine change of sterile gloves and instruments before abdominal wall closure to prevent SSI. Methods: A decision-analytic model was built to estimate average costs and outcomes of changing gloves and instruments before abdominal wall closure compared with current practice. Clinical data were obtained from the ChEETAh trial, a multicentre, cluster-randomised trial in seven low-income and middle-income countries (LMICs), and costs were obtained from a study (KIWI) that assessed costs associated with SSIs in LMICs. Outcomes were measured as the percentage of surgeries resulting in SSIs. Costs were measured from a health-care provider perspective and were reported in 2021 US$. 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.
UR - http://www.scopus.com/inward/record.url?scp=85182810622&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(23)00538-7
DO - 10.1016/S2214-109X(23)00538-7
M3 - Article
C2 - 38245114
AN - SCOPUS:85182810622
SN - 2572-116X
VL - 12
SP - e235-e242
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 2
ER -