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

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Background This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO 2 ) 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 FiO 2 , 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 FiO 2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO 2 was $216 compared with $222 for low FiO 2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO 2 was $184 compared with $195 for low FiO 2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO 2 was $1164 compared with $1257 for low FiO 2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO 2 arm had few SSIs, 7.33% compared with 8.38% for low FiO 2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion High FiO 2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.