OBJECTIVES: Surgical site infections (SSI) are one of the major nosocomial infections among hospitalized patients in India. Our objective was to carry out a decision tree analysis comparing a novel pre-operative skin prep. vs. conventional practice in-terms of comparative SSI costs to aid hospital based decision making in India.

METHODS: MEDLINE was systematically searched, pairing relevant keywords to identify English language articles describing outcomes in clinical studies. For cost impact analysis a typical private tertiary care hospital from India was considered. TreeAgePro was used for decision-tree analysis.

RESULTS: The studies showed that patients with SSI have longer stays in ICU as well as in wards, and receive multiple antibiotic regimes, which lead to increasing financial burden. Post-operative stay in patients with SSI was about 4 times longer than those without. An average increase in the cost of treatment of 3.8% for mild infections, 14.7% for moderate infections, and 29.4% for severe infections was reported in patients with SSI. Cost comparisons in India revealed total expenses incurred by patients with SSIs was Rs. 29,000 compared to Rs. 16,000 incurred by non-infected patients (Joyce, 2009). Furthermore, yearly SSI costs were reported by a study as Rs. 533,738 ± 68044 (Tiwari, 2013). Most of SSIs occur due to inadequate skin antisepsis owing to lengthy hospital practices of painting the skin using povidone iodine and alcohol. A decision tree analysis in perspective to a typical tertiary-care hospital showed that novel skin prep. comprising povidone iodine and isopropyl alcohol with half the number of steps saved Rs. 16,679 per SSI episode averted compared to conventional (betadine with alcohol/chlorhexidine) scrub. Sensitivity analysis elucidated cost of treatment of SSI as major cost driver impacting ICER.

CONCLUSIONS: The evidence depicted significant economic burden due to SSI and economic analysis showed novel skin prep. could help reduce burden of SSI and save costs.