Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries

Mwayi Kachapila; Mark Monahan; Adesoji O. Ademuyiwa; Yakubu Momohsani  Adinoyi; Bruce M. Biccard; Christina  George; Dhruva N. Ghosh; James Glasbey; Dion Morton; Osaheni  Osayomwanbo; Rupert  Pearse; Tracy Roberts; Atul  Suroy; Saidu Yusuf  Yakubu; Raymond Oppong

doi:10.1016/j.bjao.2023.100207

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries

Mwayi Kachapila^*, Mark Monahan, Adesoji O. Ademuyiwa, Yakubu Momohsani Adinoyi, Bruce M. Biccard, Christina George, Dhruva N. Ghosh, James Glasbey, Dion Morton, Osaheni Osayomwanbo, Rupert Pearse, Tracy Roberts, Atul Suroy, Saidu Yusuf Yakubu, Raymond Oppong

^*Corresponding author for this work

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Abstract

Background
This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.

Methods
Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).

Results
High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.

Conclusion
High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Original language	English
Article number	100207
Number of pages	10
Journal	BJA Open
Volume	7
Early online date	15 Jul 2023
DOIs	https://doi.org/10.1016/j.bjao.2023.100207
Publication status	E-pub ahead of print - 15 Jul 2023

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Kachapila, M., Monahan, M., Ademuyiwa, A. O., Adinoyi, Y. M., Biccard, B. M., George, C., Ghosh, D. N., Glasbey, J., Morton, D., Osayomwanbo, O., Pearse, R., Roberts, T., Suroy, A., Yakubu, S. Y., & Oppong, R. (2023). Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries. BJA Open, 7, Article 100207. Advance online publication. https://doi.org/10.1016/j.bjao.2023.100207

@article{b3d4a40804ec4732a8e955d2c0aeefbf,

title = "Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries",

abstract = "BackgroundThis study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.MethodsDecision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).ResultsHigh FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.ConclusionHigh FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.",

author = "Mwayi Kachapila and Mark Monahan and Ademuyiwa, {Adesoji O.} and Adinoyi, {Yakubu Momohsani} and Biccard, {Bruce M.} and Christina George and Ghosh, {Dhruva N.} and James Glasbey and Dion Morton and Osaheni Osayomwanbo and Rupert Pearse and Tracy Roberts and Atul Suroy and Yakubu, {Saidu Yusuf} and Raymond Oppong",

year = "2023",

month = jul,

day = "15",

doi = "10.1016/j.bjao.2023.100207",

language = "English",

volume = "7",

journal = "BJA Open",

publisher = "Elsevier",

}

Kachapila, M , Monahan, M, Ademuyiwa, AO, Adinoyi, YM, Biccard, BM, George, C, Ghosh, DN, Glasbey, J , Morton, D, Osayomwanbo, O, Pearse, R, Roberts, T, Suroy, A, Yakubu, SY & Oppong, R 2023, 'Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries', BJA Open, vol. 7, 100207. https://doi.org/10.1016/j.bjao.2023.100207

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries. / Kachapila, Mwayi ; Monahan, Mark; Ademuyiwa, Adesoji O. et al.
In: BJA Open, Vol. 7, 100207, 15.07.2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries

AU - Kachapila, Mwayi

AU - Monahan, Mark

AU - Ademuyiwa, Adesoji O.

AU - Adinoyi, Yakubu Momohsani

AU - Biccard, Bruce M.

AU - George, Christina

AU - Ghosh, Dhruva N.

AU - Glasbey, James

AU - Morton, Dion

AU - Osayomwanbo, Osaheni

AU - Pearse, Rupert

AU - Roberts, Tracy

AU - Suroy, Atul

AU - Yakubu, Saidu Yusuf

AU - Oppong, Raymond

PY - 2023/7/15

Y1 - 2023/7/15

N2 - BackgroundThis study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.MethodsDecision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).ResultsHigh FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.ConclusionHigh FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

AB - BackgroundThis study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa.MethodsDecision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($).ResultsHigh FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs.ConclusionHigh FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

U2 - 10.1016/j.bjao.2023.100207

DO - 10.1016/j.bjao.2023.100207

M3 - Article

VL - 7

JO - BJA Open

JF - BJA Open

M1 - 100207

ER -

Kachapila M , Monahan M, Ademuyiwa AO, Adinoyi YM, Biccard BM, George C et al. Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low-and middle-income countries. BJA Open. 2023 Jul 15;7:100207. Epub 2023 Jul 15. doi: 10.1016/j.bjao.2023.100207