Cost-benefit analysis of surveillance for surgical site infection following caesarean section
Cost-benefit analysis of surveillance for surgical site infection following caesarean section
复制标题
DOI：
10.1136/bmjopen-2020-036919
复制
发表时间：
2020-07-01
期刊：
影响因子：
2.9
通讯作者：
Lamagni, Theresa
中科院分区：
文献类型：
--
作者：
Wloch, Catherine;Van Hoek, Albert Jan;Lamagni, Theresa
目的评估剖宫产术后手术部位感染给卫生服务带来的经济负担，并确定通过实施监测计划可实现的潜在节省。设计经济学模型，从社区和医院卫生保健提供者的角度评估监测的成本和收益。背景是英格兰。参与者在国家卫生服务医院接受剖腹产的妇女。主要结果衡量剖宫产术后手术部位感染的治疗和管理费用。结果按感染风险9.6%计算，一家医院每年进行800次剖宫产的成本(2010年)估计为18 914英镑(95%可信区间为11521~29499)，其中28%来自社区护理(5370英镑)。将通货膨胀计入2019年的价格，这相当于2018-2019年英格兰每年进行的所有剖腹产的估计成本为500万英镑，在医院和社区管理的每个感染分别约为1866英镑和93英镑。一家医院一个日历季度的监测成本估计为3747英镑(2010年成本)。在连续监测期间感染风险降低30%、20%或10%的模型表明，可变间歇监测策略实现了比连续监测更高或类似的净节省。当基线感染风险为10%或15%时，可变监测策略比连续监测更快达到盈亏平衡，基线风险为5%时损失较小。结论对剖宫产术后感染进行监测，并向手术团队反馈数据，为降低感染风险、改善患者体验、节省医疗费用提供了一种潜在的有效手段。
Objective To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. Design Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. Setting England. Participants Women undergoing caesarean section in National Health Service hospitals. Main outcome measure Costs attributable to treatment and management of surgical site infection following caesarean section. Results The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at 18 pound 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (5370) pound. With inflation to 2019 prices, this equates to an estimated cost of 5.0 pound m for all caesarean sections performed annually in England 2018-2019, approximately 1866 pound and 93 pound per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as 3747 pound (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. Conclusion Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.