Cost-effectiveness analysis of three methods of surgical-site infection surveillance: Less is more

• Published in: American journal of infection control 2020-10, Vol.48 (10), p.1220-1224
• Main Authors: Abu-Sheasha, Ghada Ahmed, Bedwani, Ramez Naguib, Anwar, Medhat Mohamed, Yassine, Omaima Gaber
• Format: Article
• Language: English
• Subjects: Decision- support; Economic evaluation; Inpatient surveillance; Outpatient-clinic surveillance; Phone surveillance
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2019.12.022

•Compared to out-patient clinic surveillance, phone surveillance proved to be more effective (in terms of percentage of followed and detected cases) and less costly.•Data collected by phone surveillance are reliable.•There is a weak evidence that out-patient clinic surveillance might overestimate the incidence of SSI.•Loss to follow-up was much lower in case of phone surveillance.•At every setting, costs and effectiveness of different surveillances should be examined before adopting any of them. A considerable proportion of surgical site infections (SSI) could be prevented by surveillance. The study aimed to compare the cost-effectiveness of 3 methods of SSI surveillance: Inpatient, phone, and out-patient clinic (OPC); to ensure that the risk of SSI is independent from loss-to-follow-up in phone and OPC surveillances, and to determine the reliability of phone surveillance. A cohort of 351 surgical patients were followed by 3 different surveillance methods: inpatient, follow-up in OPC and over the phone. Costs of nurse time and phone calls were expressed in 2019 USD. Effectiveness of surveillance was assessed using number of detected SSIs. Phone surveillance was more cost-effective than OPC surveillance. Compared to inpatient surveillance, the OPC method costs USD 15.6 per extra detected SSI, whereas the phone method costs only USD 4.6 In phone and OPC surveillances, the risk of SSI was independent of loss-to-follow-up. However, the higher rate of SSI among OPC attendees raises the suspicion that the incidence of SSI estimated by OPC surveillance could be biased upward. Phone surveillance was reliable with high sensitivity and specificity. Phone surveillance was a reliable cost-effective method. Inpatient surveillance was less effective, but it still can be used to detect severe SSI at low cost. While out-patient-clinic surveillance had the highest cost, the incidence estimated by it might be biased upward.