Preliminary model assessing the costeffectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa
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Date
2021-08-12
Authors
Kachapila, M
Ademuyiwa, AO
Biccard, BM
Ghosh, DN
Glasbey, J
Mohanan, M
Moore, R
Morton, DG
Oppong, R
Pearse, R
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS ONE
Abstract
Background
Pneumonia is a common and severe complication of abdominal surgery, it is associated
with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary
complication rates have risen during the SARS-CoV-2 pandemic. This study explored the
potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus
no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients.
Methods
A decision analytic model taking the South African healthcare provider perspective was constructed
to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30
days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii)
the presence of COVID-19. Input parameters were collected from published literature
including prospective cohort studies and expert opinion. Effectiveness was measured as
proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic
sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness
acceptability curves.
Results
In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-
surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia
patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the
presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash
more dominant as it was more beneficial to reduce pneumonia patients through
administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash
surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness
to pay thresholds.
Conclusions
Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention
for reducing pneumonia after abdominal surgery. However, the available evidence
for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an
urgent need for a robust clinical trial on the intervention on non-cardiac surgery.
Description
Scholarly article
Keywords
Pneumonia , healthcare costs , SARS-CoV-2 pandemic , Abdominal surgery , Research Subject Categories::MEDICINE::Surgery
Citation
Kachapila M, Ademuyiwa AO, Biccard BM, Ghosh DN, Glasbey J, Monahan M, et al. (2021) Preliminary model assessing the costeffectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa. PLoS ONE 16(8): e0254698. https://doi.org/ 10.1371/journal.pone.0254698