A Budget Impact Analysis of Three Surgical Skin Antisepsis Protocols

Background:

Surgical site infections (SSIs) occur in up to 11.6% of surgeries, lengthening hospital stays and incurring additional costs.  Surgical antiseptic solutions vary in the rates of SSIs and their impact on a hospital or surgical center’s budget.

Objective:

The purpose of this study was to estimate the net budget impact of three antiseptic solutions: DuraPrep, ChloraPrep, and povidone-iodine scrub-paint (PI).

Methods:

A budget impact analysis using International Society of Pharmacoeconomics and Outcomes Research (ISPOR) and Canadian guidelines was completed.  Costs associated with DuraPrep, ChloraPrep, and PI were obtained from current market sources.  Rates of SSIs were derived from published clinical studies.  Incremental costs to treat SSIs were derived from literature and adjusted to current U.S. dollars using the medical component of the Consumer Price Index.  Surgical skin preparation time estimates were obtained from product literature and costs calculated based on per minute surgical suite charges.  Total cost per 100 surgeries was calculated: [antisepsis cost per one unit + costs of surgical preparation + Incremental costs to treat SSIs (SSI rate X 100 X average cost to treat SSI)].  Estimates were prepared in an interactive spreadsheet to modify cost parameters and rates of SSIs based on hospital specific experiences. The number of units may also be modified to reflect a difference in the number required to prepare a similar skin surface area as coverage may vary by product.  Typically, it would take approximately 2.5 ChloraPrep (26mL) applicators to 1 DuraPrep (26mL) applicator or 4 ounces of PI) to cover the same surface area.

Results:

PI had the lowest product cost, but its skin preparation protocol took 5 times longer than DuraPrep or ChloraPrep, resulting in large surgical expenditures.  At the one unit level, ChloraPrep was 1.7 times more expensive than DuraPrep and 100 times more expensive than PI. ChloraPrep also had the highest SSI rate (DuraPrep: 4.8%, ChloraPrep: 8.2%, PI (with an alcohol paint): 4.8%). DuraPrep resulted in cost-savings compared with both PI and ChloraPrep. The total costs per 100 surgeries using DuraPrep, ChloraPrep, and PI were $166,920, $274,508, and $216,500 respectively.  The cost savings difference was due to: 1) reduced preparation time (DuraPrep: 3mins, ChloraPrep: 3mins, PI: 13mins); 2) lower SSIs; and 3) per unit product cost difference (DuraPrep: $4.27, ChloraPrep: $7.08, and PI: $0.07).

Conclusions:

Based on 100 surgeries DuraPrep provides both time and cost savings relative to PI and ChloraPrep.