title: Economic and clinical contributions of an antimicrobial barrier dressing: a strategy for the reduction of surgical site infections.
abstract: OBJECTIVE
  In patients at risk of surgical site infection (SSI), there is evidence that an antimicrobial barrier dressing (Acticoat* ) applied immediately post-procedure is effective in reducing the incidence of infection. The objective of this study was to assess when it is appropriate to use an antimicrobial barrier dressing rather than a post-operative film dressing, by evaluating the net cost and budget impact of the two strategies.
  
  
  METHODS
  An economic model was developed, which estimates expected expenditure on dressings and the expected costs of surgical site infection during the initial inpatient episode, based on published literature on the pre-discharge costs of surgical infection and the efficacy of an antimicrobial barrier dressing in preventing SSI.
  
  
  RESULTS
  At an SSI risk of 10%, an antimicrobial barrier dressing strategy is cost neutral if the incidence of infection is reduced by at least 9% compared with a post-operative film dressing. At 35% efficacy, expenditure on dressings would be higher by £30,760 per 1000 patients, and the cost of treating infection would be lower by £111,650, resulting in a net cost saving of £80,890. The break-even infection risk for cost neutrality is 2.6%.
  
  
  CONCLUSIONS
  Although this cost analysis is based on published data, there are limitations in methodology: the model is dependent on and subject to the limitations of the data used to populate it. Further studies would be useful to increase the robustness of the conclusions, particularly in a broader range of surgical specialties.
  
  
  CONCLUSIONS
  A strategy involving the use of an antimicrobial barrier dressing in patients at moderate (5-10%) or high (>10%) risk of infection appears reasonable and cost saving in light of the available clinical evidence.
authors.affiliation: Department of Wound Healing, Cardiff University, Cardiff, Wales, UK. profdavidleaper@doctors.org.uk
authors.forename: David
authors.initials: D
authors.lastname: Leaper
authors.forename: Jameel
authors.initials: J
authors.lastname: Nazir
authors.forename: Chris
authors.initials: C
authors.lastname: Roberts
authors.forename: Richard
authors.initials: R
authors.lastname: Searle
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000191:economics*; D019072:Antibiotic Prophylaxis / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D006801:Humans; D018803:Models, Economic; D009779:Occlusive Dressings / Q000191:economics*; D013530:Surgical Wound Infection / Q000191:economics* / Q000517:prevention & control*; D006113:United Kingdom
chemical_list: D000890:Anti-Infective Agents