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

Abstract

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.

Surgical Antimicrobial Prophylaxis in Neonates and Children with Special High-Risk Conditions: A RAND/UCLA Appropriateness Method Consensus Study

“…SSIs are an ever-increasing phenomenon worldwide due to different factors and are responsible for generating important costs [ 51 , 52 ]. This cost depends on many factors, including the patient himself and the type of surgery [ 53 ].…”

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

“…28 All studies evaluated in a systematic review reported some economic benefit associated with SSI prevention, but there is significant heterogeneity in the literature related to cost accounting. 29,30 In the United States, SSIs are believed to account for $3.5 billion to $10 billion annually in healthcare expenditures. 31,32 Finally, data reported to the CDC NHSN show that SSIs can be caused by antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus , vancomycin-resistant Enterococci, and multidrug-resistant gram-negative bacilli.…”

“…28 All studies evaluated in a systematic review reported some economic benefit associated with SSI prevention, but there is significant heterogeneity in the literature related to cost accounting. 29,30 In the United States, SSIs are believed to account for $3.5 billion to $10 billion annually in healthcare expenditures. 31,32…”

Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study

“…As soon as our consensus document will be implemented by the Italian Scientific Societies, it will be interesting to analyze its clinical and economic impact in our geographical context. However, our recommendations could be generalized also in low- and middle-income countries where it has been recently highlighted the impact of simple, cost-effective, sustainable, and adaptable strategies on the reduction of SSIs morbidity risk and the associated costs [ 130 , 131 , 132 ].…”