An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical-site infection in coronary artery bypass graft in India

Abstract

Background: The incidence of surgical site infections (SSIs) is higher in India compared to the rest of the world. In patients undergoing coronary artery bypass graft (CABG), the risk is even higher. SSI following CABG is associated with an additional length of stay (LOS) resulting in additional costs, thus causing a significant economic burden on patients and society. We aimed to determine the additional costs and LOS due to SSIs after CABG and to evaluate the efficacy of triclosan-coated sutures (TCS) in reducing the SSI rate. Methodology: A systematic literature search of available evidence for both epidemiologic and economic data related to the incidence of SSI (from 1998 to 2018) and efficacy of TCS (from 2000 to 2018) respectively, were gathered. We compared 100 surgeries from private and public hospitals for CABG and calculated cost-effectiveness of TCS in comparison to conventional nonantimicrobial-coated sutures (NCS) using a decision-tree cost model. Results: Three studies were analyzed out of 109 citations for the analysis of SSI incidence and for the efficacy of TCS versus NCS, five studies were included. We performed a one-way sensitivity analysis to calculate the impact of efficacy (%) and SSI incidences (%) and cost of NCS and TCS on cost savings depicted by Tornado charts. Sensitivity analysis on the comparison of TCS with NCS, a base cost saving of CABG for a private hospital was INR 14,476 and public hospital INR 4145. Conclusion: The use of TCS reduced SSI incidence and cost savings for CABG surgeries in both public and private sectors in India.

Keywords

• coronary artery bypass graft
• nonantimicrobial coated suture
• surgical site infection
• triclosan-coated suture