Cost-benefit analysis of surveillance for surgical site infection following caesarean section

Catherine Wloch*, Albert Jan Van Hoek, Nathan Green, Joanna Conneely, Pauline Harrington, Elizabeth Sheridan, Jennie Wilson, Theresa Lamagni

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)
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Objective: To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. 

Design: Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers' perspective. 

Setting: England. 

Participants: Women undergoing caesarean section in National Health Service hospitals. 

Main outcome measure: Costs attributable to treatment and management of surgical site infection following caesarean section. 

Results: The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18 914 (95% CI 11 521 to 29 499) with 28% accounted for by community care (£5370). With inflation to 2019 prices, this equates to an estimated cost of £5.0 m for all caesarean sections performed annually in England 2018-2019, approximately £1866 and £93 per infection managed in hospital and community, respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3747 (2010 costs). Modelling a decrease in risk of infection of 30%, 20% or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10% or 15% and smaller loses with a baseline risk of 5%. 

Conclusion:; Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service.

Original languageEnglish
Article numbere036919
JournalBMJ Open
Issue number7
Publication statusPublished - 20 Jul 2020

Bibliographical note

Funding Information: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Open Access:
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Publisher Copyright: © Author(s) (or their employer(s)) 2020. Published by BMJ.

Citation: Wloch C, Van Hoek AJ, Green N, et al. Cost–benefit analysis of surveillance for surgical site infection following caesarean section. BMJ Open 2020;10:e036919.

DOI: 10.1136/bmjopen-2020-036919


  • epidemiology
  • health economics
  • maternal medicine


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