title: Health Utility Values Associated with Surgical Site Infection: A Systematic Review.
abstract: BACKGROUND
  Surgical site infection (SSI) is a costly postoperative complication whose impact on patients' health-related quality of life is highly uncertain and has not been summarized to date.
  
  
  OBJECTIVE
  The objective was to summarize the evidence base on SSI health utility values reported in patient-level studies and decision models.
  
  
  METHODS
  A systematic review of SSI utility values reported in patient-level and decision modeling studies was carried out. Studies in which utility values for SSI were either invoked (e.g., model-based economic evaluations) or elicited (e.g., valuation exercises), or at least one non-preference-based instrument was administered to patients with SSI after open surgery were included. Mapping algorithms were used, where appropriate, to calculate utilities from primary data. Results were summarized narratively, and the quality of the utility values used in the included modeling studies was assessed.
  
  
  RESULTS
  Of 6552 records identified in the database search, 28 studies were included in the review: 19 model-based economic evaluations and 9 patient-level studies. SSI utility decrements ranged from 0.04 to 0.48, of which 19 ranged from 0.1 to 0.3. SSI utility decrements could be calculated for three patient-level studies, and their values ranged from 0.05 (7 days postoperatively) to 0.124 (1 year postoperatively). In most modeling studies, SSI utilities were informed by authors' assumptions or by secondary sources.
  
  
  CONCLUSIONS
  SSI may substantially affect patients' health utility and needs to be considered when modeling decision problems in surgery. The evidence base for SSI utilities is of questionable quality and skewed toward orthopedic surgery. Further research must concentrate on producing reliable estimates for patients without orthopedic problems.
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. Electronic address: adrian.e.gheorghe@gmail.com.
authors.forename: Adrian
authors.initials: A
authors.lastname: Gheorghe
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Grace
authors.initials: G
authors.lastname: Moran
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Duffy
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: Tracy
authors.initials: T
authors.lastname: Roberts
authors.affiliation: Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pinkney
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Calvert
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D006305:Health Status Indicators; D006801:Humans; D017059:Models, Econometric; D011788:Quality of Life; D013530:Surgical Wound Infection / Q000191:economics* / Q000523:psychology*
keywords: health utility; surgical site infection; systematic review