Welcome To The Fifth NIHR GSU Newsletter

Health Economics is the study of how we make health and healthcare choices with finite resources. With constraints on finances, workforce capacity, and infrastructure, it is important to allocate these limited resources in a manner to promote their efficient use and to make sure that we get the maximum benefit. The NIHR Global Health Research Unit on Global Surgery (GSU) has embedded health economics across its project portfolio to support decision making in limited-resource settings. The Unit has two dedicated health economists (Mark Monahan & Mwayi Kachapila) to help drive the research forward.

The ongoing health economics activities within the Unit include systematic reviews, economic modelling, cost studies, and economic evaluations alongside GSU trials.

Surgical Site Infection (SSI)
SSI is a key outcome measure in the Unit’s FALCON, CHEETAH, and PENGUIN trials. To understand the current cost literature of SSI and the methodological challenges in estimating the financial burden of SSI, we did a systematic review of the costs of SSI in low- and middle- income countries¹.

We were also interested in the potential scale of the financial burden of SSI across income settings. A cost of illness study, using the GlobalSurg datasets to populate the model, will quantify the cost burden of SSI in appendectomy patients.

Primary data collection on the costs associated with SSI is currently being collected as part of a dedicated FALCON substudy. The Key resource use In Wound Infection (KIWI) substudy is collecting data across three continents amongst adult FALCON patients.

One of the Unit’s health economists (Mark Monahan) is doing a staff PhD on the economics of SSI in low- and middle- income countries. The PhD will look at both the costs and quality of life information of the SSI to help support decision making in these settings.

Pneumonia
Pneumonia is an important co-primary outcome of the PENGUIN study. Before the main trial commences, early economic modelling is underway to assess the preliminary cost-effectiveness of the trial interventions. Findings from the model will provide intuition of the main cost drivers and prioritize data collection efforts of important uncertain variables for the planned trial-based economic evaluation of PENGUIN.

Task-shifting
The lack of the surgical workforce is a major challenge in rural settings in Ghana. Task-shifting may provide a sustainable means of addressing unmet surgical need. The TIGER trial will assess task shifting between surgeons and non-surgeon physicians in inguinal hernia repair. Quantifying the costs and benefits of increasing access to surgery will be a significant aim of the health economics analysis.

Reference
1.  Monahan M, Jowett S, Pinkney T, et al. Surgical site infection and costs in low-and middle-income countries: A systematic review of the economic burden. Plos one. 2020;15(6):e0232960.

CEI activity is rapidly picking up pace within the Unit’s pump-priming studies, most recently in the Abdominal TB study in India and the Burns study in South Africa.

In addition, the CEI survey set up with the NIHR was distributed amongst participating global health researchers to capture the impact of the COVID-19 pandemic on CEI activity in LMICs, highlighting barriers and solutions, and mapping best practice during the global pandemic. A focus group on this topic was also conducted with NIHR-funded global health researchers based in LMICs. The qualitative data from 31 survey participants and the outcomes of the focus group have been analysed and a report is being written to be shared with the NIHR CEI working group and steering committee. Findings will be shared widely in form of a publication, on social media platforms and potentially via webinars – highlighting this as an excellent example for shared learning

New GlobalSurg-CovidSurg Study!

• To assess key global surgical indicators, including postoperative mortality.
• To determine the optimal timing of surgery following SARS-CoV-2 infection. All patients are eligible to be included regardless of their SARS-CoV-2 status, so all hospitals can get involved even if they have not had any SARS-CoV-2 patients.

• Prospective, observational cohort study, with no changes to patient management.
• All hospitals can participate
• All surgical specialties can participate
• Data collection will be in 7-day blocks in October 2020.
• All collaborators will be included as PubMed citable co-authors on resulting publications.

CovidSurg continues to go from strength to strength. Numerous publications are imminent from the CovidSurg Cohort and Cancer studies and recent publications have received extensive attention worldwide for example COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet. 2020 Jul 4;396(10243):27-38: