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

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 FiO_2, 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.

Keywords: abdominal surgery; cost-effectiveness analysis; global surgery; high fraction of inspired oxygen; low-and middle-income countries; surgical site infection.