title: Cost analysis of gentamicin-impregnated collagen sponges in preventing sternal wound infection post cardiac surgery.
abstract: OBJECTIVE
  The use of antibiotic-impregnated sponges (Collatamp) during cardiac surgery is controversial. We analysed the cost-effectiveness of its selective use in patients at high-risk of sternal wound infection (SWI).
  
  
  METHODS
  Postoperative costs were analysed in two groups of patients undergoing heart surgery between 2011 and 2013: those with SWI (group 1) and in high-risk patients without SWI (group 2). The potential cost of gentamicin-impregnated collagen sponges (GCS) use in high-risk patients was compared with our current practice.
  
  
  RESULTS
  We identified 1,251 patients with at least one recognised risk factor for developing SWI in this period. Of these, 18 developed SWI (incidence 1.4%). The median postoperative cost per patient without SWI was £9,617. The additional cost per patient incurred by SWI was £4,860.75. The annual additional cost for treating patients with SWI was £43,749. With a 50% reduction in SWI, the annual additional cost of treating these patients would be reduced to £21,873. The cost of GCS is £80 per patient. Adding this to £21,873 gives a potential total cost of £71,913 in the treated high-risk cohort.
  
  
  CONCLUSIONS
  In our practice the annual cost of treating SWI in high-risk patients without use of GCS is lower than the annual cost of using GCS in all high-risk patients (£43,749 versus £71,913) if it produces a 50% reduction in SWI. The reduction in the incidence of SWI poses no economic benefit when the cost of the product is factored in.
authors.affiliation: Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham, U.K.
authors.forename: V
authors.initials: V
authors.lastname: Joshi
authors.affiliation: Department of Cardiac Surgery, Glenfield Hospital Leicester, U.K.
authors.forename: R
authors.initials: R
authors.lastname: Vaja
authors.affiliation: Department of Cardiac Surgery, Trent Cardiac Centre, Nottingham, U.K.
authors.forename: D
authors.initials: D
authors.lastname: Richens
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003094:Collagen / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D005839:Gentamicins / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D013249:Sternum / Q000601:surgery; D015503:Surgical Sponges / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003094:Collagen
keywords: Collatamp; cost analysis; gentamicin-impregnated collagen sponge; sternal wound infection