Kachapila Mwayi, Nepogodiev Dmitri, Kadir Bryar, Picciochi Maria, Kamarajah Sivesh K, Bhangu Aneel, Oppong Raymond
Applied Health Sciences, University of Birmingham-Edgbaston Campus, Birmingham, UK.
University of Birmingham, Birmingham, UK.
BMJ Surg Interv Health Technol. 2025 Jun 12;7(1):e000383. doi: 10.1136/bmjsit-2025-000383. eCollection 2025.
A recent meta-analysis of high-quality randomized trials casts doubt on the effectiveness of triclosan-coated sutures in reducing surgical site infection (SSI). This economic analysis is aimed at assessing whether triclosan-coated sutures, compared with uncoated sutures, can reduce costs from a healthcare perspective.
This was a model-based economic analysis mainly informed by baseline SSI rates, effect size CIs from a recent meta-analysis of high-quality trials (OR 0.90, 95% CI 0.74 to 1.09, p=0.29), and country-specific cost data.
This was a worldwide analysis that estimated average cost savings aggregated for high, middle, and low Human Development Index (HDI) countries and country-specific cost savings for the 193 countries on the HDI list.
Participants were patients undergoing abdominal surgery. The analysis was informed by baseline SSI rates from an international cohort study (12 539 patients).
Results are reported in 2022 US dollars as average cost differences associated with SSI between coated and uncoated sutures. Deterministic sensitivity analyses examined variations in suture cost, hospital stay costs, and effect size, with best and worst-case scenario analyses.
SSI-related cost differences per patient ranged from -$466 to $171 in high-HDI, -$23 to $18 in middle-HDI, and -$34 to $22 in low-HDI countries when triclosan-coated sutures were used. The largest potential savings and expenditure occurred in contaminated-dirty wounds. Similar results were observed at the national level in 184 of 193 countries. Best-case to worst-case analyses showed a range of -$533 to $192 in high-HDI, -$57 to $49 in middle-HDI and -$69 to $52 in low-HDI countries.
This analysis highlights significant uncertainty regarding cost savings with routine use of triclosan-coated sutures, emphasizing the need for high-quality data and CI-based economic analysis in policy making.
最近一项对高质量随机试验的荟萃分析对含三氯生缝线在降低手术部位感染（SSI）方面的有效性提出了质疑。本经济分析旨在从医疗保健角度评估与未涂层缝线相比，含三氯生缝线是否能降低成本。
这是一项基于模型的经济分析，主要依据基线SSI发生率、最近高质量试验荟萃分析的效应量置信区间（OR 0.90，95%CI 0.74至1.09，p = 0.29）以及特定国家的成本数据。
这是一项全球分析，估计了高、中、低人类发展指数（HDI）国家汇总的平均成本节约情况以及HDI列表中193个国家的特定国家成本节约情况。
参与者为接受腹部手术的患者。该分析依据一项国际队列研究（12539名患者）的基线SSI发生率。
结果以2022年美元报告，为含涂层和未涂层缝线之间与SSI相关的平均成本差异。确定性敏感性分析通过最佳和最坏情况分析，研究了缝线成本、住院费用和效应量的变化。
在高HDI国家，使用含三氯生缝线时，每名患者与SSI相关的成本差异范围为 - 466美元至171美元；在中HDI国家为 - 23美元至18美元；在低HDI国家为 - 34美元至22美元。最大的潜在节约和支出发生在污染 - 脏污伤口。在193个国家中的184个国家的国家层面观察到了类似结果。最佳情况到最坏情况分析显示，高HDI国家的范围为 - 533美元至192美元；中HDI国家为 - 57美元至49美元；低HDI国家为 - 69美元至52美元。
本分析突出了常规使用含三氯生缝线在成本节约方面存在的重大不确定性，强调在决策过程中需要高质量数据和基于置信区间的经济分析。
