Evaluation of the costing methodology of published studies estimating costs of surgical site infections: A systematic review.

OBJECTIVES: Surgical site infections (SSIs) are associated with increased length of hospitalization and costs. Epidemiologists and infection control practitioners, who are in charge of implementing infection control measures, have to assess the quality and relevance of the published SSI cost estimates before using them to support their decisions. In this review, we aimed to determine the distribution and trend of analytical methodologies used to estimate cost of SSIs, to evaluate the quality of costing methods and the transparency of cost estimates, and to assess whether researchers were more inclined to use transferable studies. METHODS: We searched MEDLINE to identify published studies that estimated costs of SSIs from 2007 to March 2021, determined the analytical methodologies, and evaluated transferability of studies based on 2 evaluation axes. We compared the number of citations by transferability axes. RESULTS: We included 70 studies in our review. Matching and regression analysis represented 83% of analytical methodologies used without change over time. Most studies adopted a hospital perspective, included inpatient costs, and excluded postdischarge costs (borne by patients, caregivers, and community health services). Few studies had high transferability. Studies with high transferability levels were more likely to be cited. CONCLUSIONS: Most of the studies used methodologies that control for confounding factors to minimize bias. After the article by Fukuda et al, there was no significant improvement in the transferability of published studies; however, transferable studies became more likely to be cited, indicating increased awareness about fundamentals in costing methodologies.

Vaccine wastage and cost saving after multi-dose vial policy implementation in Egypt: A success story.

BACKGROUND: Prevention of disease through vaccination is one of the greatest public health successes. The Expanded Program of Immunization (EPI) previous policy stated that all vaccines had opened for immunization session had to be discarded at the end of the session, regardless to the type of the vaccine or the number of doses remaining in the vial. To bring wastage rate down, the WHO multi-dose vial policy (MDVP) was introduced. It stated that multi dose liquid vaccine vials, from which one or more doses have been administered, may be used for subsequent immunization session up to 28 days in the recommended manufacture storage conditions provided that certain condition must be met. The EPI in Egypt had adopted the MDVP in 2016. The current study aimed to evaluate the impact of implementation MDVP on vaccine wastage rate in Alexandria, and to estimate the cost reduction after that policy. METHODS: Information regarding to vaccine doses consumed and children vaccinated were retrieved from medical districts and primary health care units for the period from January 1st 2014 to October 31st 2018. Interrupted time series design with control was conducted to determine the level change and trend change for the policy vaccines and for estimating the average cost saved after the policy. RESULTS: The adoption of MDVP led to a significant reduction in the wastage rates of Pentavalent vaccine by 84.7%, DPT vaccine by 82.5% and OPV by 32%. Thus, by implementation of MDVP the estimated annual cost saved for the policy vaccine in all Egypt could be USD2,449,07995%CI826,076to12,219,869. CONCLUSION: The implementation of MDVP in Alexandria made a significant reduction in the vaccine wastage rate which led to a saving in vaccine requirement and by consequence a cost saved.

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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.