Preliminary model assessing the cost-effectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa
| Autor: | Kitty Hiu Fung Wong, William Waldock, Omar Ezzat Saber Mostafa, Raymond Oppong, Dion Morton, Soham Bandyopadhyay, Hari Bhachoo, Lorraine Ochieng, Rupert Pearse, Graeme Burt, Daniel Field, Thomas Pinkney, Josephine Walshaw, Yong Yong Tew, Hadyn K.N. Kankam, STARSurg Collaborative, Melika Akhbari, James Glasbey, Mahan Salehi, Michael Smith, George Higginbotham, Amanda Caroline Dawson, Mark Monahan, Lee Cooper, CHRISTOS KONTOVOUNISIOS, Jennifer Ritehnia, Mohamed Rabie, Peter Cripps, Edward Lau, Sanchita Bhatia, Thomas Ashdown, Mahmoud ElFiky, Mwayi Kachapila, Aneel Bhangu |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness General Science & Technology Science Cost-Benefit Analysis Mouthwashes Preoperative care South Africa Postoperative Complications stomatognathic system Abdomen Preoperative Care medicine Humans Prospective Studies ASOS Investigators Prospective cohort study Pandemics Multidisciplinary Science & Technology STARSurg Collaborative business.industry Chlorhexidine ECONOMIC OUTCOMES COVID-19 Cost-effectiveness analysis Pneumonia Models Theoretical medicine.disease Cardiac surgery Clinical trial body regions Multidisciplinary Sciences Emergency medicine Medicine Science & Technology - Other Topics NIHR Global Health Research Unit on Global Surgery business Research Article Abdominal surgery |
| Zdroj: | PLoS ONE, Vol 16, Iss 8, p e0254698 (2021) PLoS ONE |
| Popis: | Background Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. Methods A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. Results In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. Conclusions Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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