Abstract
OBJECTIVES: 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. DESIGN: 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. SETTING: 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: Participants were patients undergoing abdominal surgery. The analysis was informed by baseline SSI rates from an international cohort study (12 539 patients). MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.