Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures

BackgroundDespite several randomized trials, systematic reviews and meta-analyses that have demonstrated the effectiveness of antimicrobial (triclosan-coated or -impregnated) sutures (TCS), the clinical and economic impact of using these sutures compared with conventional non-antimicrobial-coated absorbable sutures (NCS) remains poorly documented. MethodsAn independent systematic review and meta-analysis of all published evidence from January 2005 to September 2016 comparing TCS with NCS was conducted. Surgical-site infection (SSI) was the primary outcome. The results of the meta-analysis were used in a decision-tree deterministic and stochastic cost model, using the National Health Service (NHS England)-based cost of inpatient admissions for infections and differential costs of TCSversusNCS. ResultsThirty-four studies were included in the final assessment from an initial 163 identified citations; 20 of 34 studies were randomized, and 17 of 34 reported blinding of physicians and assessors. Using a random-effects model, the odds ratio for SSI in the TCS compared with NCS control groups was statistically significant (odds ratio 061, 95 per cent c.i. 052 to 073; P < 0001). There was significant heterogeneity (I-2 = 49 per cent). Using random-effects event estimates of SSI for TCS and NCS for each individual wound type, the mean savings per surgical procedure from using antimicrobial sutures were significant: 9125 (90 per cent c.i. 4962 to 14276) (Euro10509 (5715 to 16441); exchange rate 15 November 2016) across all wound types. ConclusionThe reviewed literature suggested that antimicrobial sutures may result in significant savings across various surgical wound types.