An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical site infection in obstetrics and gynecological surgeries in India

Objectives: The present study demonstrates the efficacy and economic outcome of triclosan-coated sutures (TCS) Vs conventional non-antimicrobial-coated sutures (NCS) for surgical site infections (SSIs) in obstetrics and gynecology (Ob/Gyn) in India. Materials and Methods: A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India from 1998-2018 and 2000-2018, respectively, were gathered. We collected cost data from a private and public hospital, respectively for both Laparoscopic hysterectomy (L-hysterectomy) and Cesarean-section (C-section). Cost-effectiveness of TCS in comparison to the conventional NCS was calculated using a decision-tree deterministic model. Results: We performed one-way sensitivity analysis to compare TCS with NCS. We found a base cost - saving for C-section at private hospital, INR 5513 and public hospital INR 791 whereas for L-hysterectomy it was INR 4924 at private hospital and INR 999 at public hospital. For C-section, at private hospital, the cost-saving for SSIs per 100 surgeries at SSI incidence rates (3.77%, 7.94%, and 24.2% at low efficacy (41%) (INR 2,05,508, INR 4,41,668, and INR 13,62,526, ) and high efficacy (61%) were (INR 3,09,657, INR 6,61,018, and INR 20,31,075). For L-hysterectomy, at private hospital, the cost- saving for SSIs per 100 surgeries for SSI incidence rates (2.28%, 6.51%, and 11.7%) at low efficacy (41%) were (INR 1,32,902; INR 3,94,313; and INR 7,15,052, and high efficacy (61%) were (INR 2,01,635; INR 5,90,564; and INR 10,67,760). Conclusion: Decision tree modeling showed that the use of TCS resulted in cost savings for Ob/Gyn surgeries in India. Keywords: Cost savings, Nonantimicrobialcoated sutures, Obstetrics and gynecology, Surgical site infection, Triclosancoated sutures