Ms Shalini Elangovan1, Dr Choon Sheong Seow2, Professor Nicholas Graves1
1Duke-NUS Medical School, Singapore, Singapore, 2Ng Teng Fong General Hospital, Singapore, Singapore
Biography:
Ms Shalini is a 4th year PhD student at the Duke-NUS Medical School in Singapore. Her thesis focuses on the use of economic evidence in infection prevention and control decision-making.
Abstract:
Surgical site infections (SSI) contribute to increased healthcare costs and worse health outcomes. An SSI bundle intervention was implemented in a general hospital in Singapore in response to increasing SSI among abdominal surgery patients.
This study assesses the cost-effectiveness of bundle implementation for abdominal surgery patients and cost and healthcare outcomes of bundle adoption.
A decision tree model was developed to compare cost and effectiveness outcomes of incisional and organ/space SSI for index hospitalisation. Cost outcomes were estimated using bundle cost and postoperative hospital length of stay multiplied by the cost of a bed day. Effectiveness outcomes were estimated as life years gained from deaths averted. A probabilistic sensitivity analysis with Monte Carlo simulation and a Value of Information analysis were conducted.
The SSI bundle was cost-effective 74.9% of the time, cost-saving 57% of the time, and both cost-effective and cost-saving 48% of the time with a mean incremental net monetary benefit of SGD$352. A projected 1,093 bed days with a value of about SGD$899,530 will be saved, with approximately 135 cases of SSI and 86 life years gained for the next 10,000 abdominal surgery patients. The EVPI per patient for all parameters was SGD$94.96, with the probability of organ/space SSI having the highest value in the EVPPI analysis at SGD$58.89 per patient.
The SSI prevention bundle is highly likely to be cost-effective and likely to provide substantial cost-savings if implemented for abdominal surgery patients with improved patient outcomes. The results support the implementation of the bundle.