Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a model-based cost-effectiveness analysis of a pragmatic, cluster-randomised trial in seven low-income and middle-income countries
Mwayi Kachapila, Raymond Oppong, Adesoji Ademuyiwa, Aneel Bhangu, Risikat Dauda, Dhruva Ghosh, Sivesh K. Kamarajah, Ismaïl Lawani, Antonio Ramos‐De la Medina, Mark Monahan, Dion Morton, Omar Omar, Maria Picciochi, Stephen Tabiri, Tracy E. Roberts, Peter Brocklehurst, Sohini Chakrabortee, James Glasbey, Pollyanna Hardy, Ewen M. Harrison, Rachel Lillywhite, Laura Magill, Dmitri Nepogodiev, Joana Simões, Donna Smith, Bryar Kadir, Thomas Pinkney, Felicity Brant, Elizabeth Li, Emmy Runigamugabo, Michael Bahrami‐Hessari, Edward Bywater, Laura Martínez, Sosthene Habumuremyi, Faustin Ntirenganya, Emmanuel Williams, Maria Fourtounas, Bokossa K. Covalic Melic, Dhruva Ghosh, Atul Suroy, Didier Ahogni, Aristide Ahounou, K. Alassan Boukari, Oswald Gbéhadé, Thierry K Hessou, Sinama Nindopa, M.J. Bienvenue Nontonwanou, Nafissatou Orou Guessou, Arouna Sambo, Sorekou Victoire Tchati, Affisatou Tchogo, Sèmèvo Romaric Tobome, Parfait Yanto, Isidore Gandaho, Armel Hadonou, Simplice Hinvo, Montcho Adrien Hodonou, Sambo Bio Tamou, Souliath Lawani, Francis Moïse Dossou, Antoine Gaou, Roland Goudou, Marie-Claire Kouroumta, Ismaïl Lawani, Enrif Malade, Anne Stredy Mkoh Dikao, Joel Nzuwa Nsilu, Pencome Ogouyemi, Marcelin Akpla, Nathan Bisimwa Mitima, Blaise Kovohouande, Stephane Laurent Loupeda, Mamonde Victorin Agbangla, Sena Emmanuel Hedefoun, Thierry Mavoha, Juvenal Ngaguene, Janvier Rugendabanga, Rish Romaric Soton, Martin Totin, Mouhamed Agbadebo, Hubert Dewamon, Irene Akpo, Martin Djeto, Aïssatou Hada, Monsede Hollo, Albert Houndji, Anasthasie Houndote, Sylvestre Hounsa, Expedit Kpatchassou, Hugues Yome, Mohamed Moussa Alidou, Eric Jerry Bara, B.T. Bonheur Dossou Yovo, Robert Guinnou, Souleymane Hamadou, H.Pauline Kola, Nabil Moussa, Boniface Cakpo, Lolyta Etchisse, Eméry Hatangimana
Abstract
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.