An economic analysis of triclosan-coated versus uncoated sutures at preventing surgical site infection in patients undergoing abdominal surgery

Objectives: A recent meta-analysis of high-quality randomised trials cast doubt on the effectiveness of triclosan-coated sutures in reducing surgical site infection (SSI). This model-based economic analysis assessed the economic uncertainty of triclosan-coated sutures, considering a healthcare perspective.

Design, patients, and settings: We assessed the cost impact among abdominal surgery patients in high, middle, and low Human Development Index (HDI) countries. Key data sources included baseline SSI rates from an international cohort study (12 539 patients), effect size confidence intervals from a recent meta-analysis of high-quality trials (odds ratio 0.90, 95% CI 0.74-1.09, p=0.29), and costs data from 193 countries.

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 when a triclosan coated sutures was used ranged from -$466 to $171 in high-HDI, -$23 to $18 in middle-HDI, and -$34 to $22 in low-HDI countries. The largest potential saving and expenditure occurred in contaminated-dirty wounds. Similar results were observed at 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: The significant uncertainty regarding cost savings with routine use of triclosan-coated sutures, highlights the need for high-quality data and confidence interval based economic analysis in policymaking.