Preliminary model assessing the costeffectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africa

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dc.contributor.authorKachapila, M
dc.contributor.authorAdemuyiwa, AO
dc.contributor.authorBiccard, BM
dc.contributor.authorGhosh, DN
dc.contributor.authorGlasbey, J
dc.contributor.authorMohanan, M
dc.contributor.authorMoore, R
dc.contributor.authorMorton, DG
dc.contributor.authorOppong, R
dc.contributor.authorPearse, R
dc.contributor.authorRoberts, TE
dc.contributor.authorNIHR Global Health Research Unit on Global Surgery
dc.contributor.authorASOS Investigators
dc.contributor.authorSTARSurg Collaborative
dc.date.accessioned2022-08-10T16:32:34Z
dc.date.available2022-08-10T16:32:34Z
dc.date.issued2021-08-12
dc.descriptionScholarly articleen_US
dc.description.abstractBackground 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.en_US
dc.identifier.citationKachapila 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.0254698en_US
dc.identifier.urihttps://ir.unilag.edu.ng/handle/123456789/11029
dc.language.isoenen_US
dc.publisherPLOS ONEen_US
dc.subjectPneumoniaen_US
dc.subjecthealthcare costsen_US
dc.subjectSARS-CoV-2 pandemicen_US
dc.subjectAbdominal surgeryen_US
dc.subjectResearch Subject Categories::MEDICINE::Surgeryen_US
dc.titlePreliminary model assessing the costeffectiveness of preoperative chlorhexidine mouthwash at reducing postoperative pneumonia among abdominal surgery patients in South Africaen_US
dc.typeArticleen_US
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