A cost utility analysis of surgical site infection; Broadening the scope

Citation

McFarland A, Manoukian S, Mason H & Reilly J (2025) A cost utility analysis of surgical site infection; Broadening the scope. Applied Health Economics and Health Policy. https://doi.org/10.1007/s40258-025-01015-1

Abstract
Background: Surgical site infections (SSI) present a significant burden in terms of excess length of stay, distress, disability and death. SSI risk and the associated economic burden may be reduced through programmes of infection prevention and control (IPC) although evidence of their cost effectiveness is limited. Patient level data from the Evaluation of Cost of Nosocomial Infection study (ECONI) provided opportunity for analysis. Aim: To explore the cost effectiveness of enhanced SSI prevention in terms of costs and quality of life for adult surgical patients in the United Kingdom (UK) National Health Service (NHS). Methods: A Monte Carlo microsimulation model was built to evaluate the cost effectiveness (cost per QALY) of SSI prevention in three surgery types (coronary artery bypass graft, hip arthroplasty and caesarean section) by comparing an Enhanced programme of SSI IPC to current clinical sequelae over one month and one year in the NHS. Uncertainty was explored through probabilistic sensitivity analysis, scenario analysis and the use of alternative utility valuation sets. Results: In most surgeries and time points, Enhanced IPC was associated with lower costs and higher QALY gains than current SSI IPC measures. The results were sensitive to utility valuation methods used. Scenario analyses identified factors relating to SSI rate, IPC programme efficacy and cost resulted in strategy dominance changes over all three surgery types. Conclusions: Enhanced programmes of IPC for SSIs may deliver improved health outcomes at a lower cost however this is not consistent across all surgery types and timepoints and are sensitive to various factors.