PCV35 - Budget Impact Analysis of Routine Gentamicin-Collagen Implants for the Prevention of Surgical Site Infection (SSI) in High Risk Cardiothoracic Surgery Patients

Abstract

The SSI rate after cardiothoracic surgery is estimated at 7.3% by the UK Health Protection Agency (HPA) for high risk patients. This represents a burden on resources, through greater risk of in-hospital mortality and increased length of hospital stay (mean 22.1 extra days for deep SSI). Treatment guidelines recommend IV antibiotic prophylaxis before surgery; however a challenge in high-BMI and diabetic patients (high risk) is the inability of systemic antibiotics to sufficiently penetrate target tissue. It is however estimated that 40%-60% of SSIs are avoidable, with clinical data supporting additional use of local gentamicin-collagen for SSI prevention. The purpose of this study was to examine the budget impact case from a UK NHS perspective of routinely administering gentamicin-collagen local prophylaxis against SSI in high risk patients undergoing cardiothoracic surgery. A literature review was undertaken regarding gentamicin-collagen efficacy in reducing SSI in cardiothoracic patients, NHS costs of SSI, and annual UK cardiothoracic patient numbers. The SSI rate in cardiothoracic surgery was obtained from HPA data. Findings were incorporated into a decision tree budget impact model to analyse potential savings from routine use of gentamicin-collagen in high risk cardiothoracic patients. Considering a cohort of 3710 high-risk cardiothoracic patients, annual NHS costs of SSI are £2,164,316. Administration of two gentamicin-collagen implants to each high risk patient would cost £200 per patient. Assuming a 59% reduction in SSI; this would prevent 197 sternal wound infections, with direct savings of £1,590,882 per year, a net saving of £229 per cardiothoracic surgery patient. Significant NHS and hospital trust savings may be achievable through routine use of gentamicin-collagen implants in high risk cardiothoracic surgery patients. A conservative estimate of high-risk patient numbers was used in the analysis, suggesting the scope for budgetary savings could exceed reported findings.