1,721,035 research outputs found
Setting hospital infection control policy : a decision-making framework incorporating health economics and healthcare epidemiology
No full textBackground:\ud
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Reducing rates of healthcare acquired infection has been identified by the Australian Commission on Safety and Quality in Health Care as a national priority. One of the goals is the prevention of central venous catheter-related bloodstream infection (CR-BSI). At least 3,500 cases of CR-BSI occur annually in Australian hospitals, resulting in unnecessary deaths and costs to the healthcare system between 95.3 million. Two approaches to preventing these infections have been proposed: use of antimicrobial catheters (A-CVCs); or a catheter care and management ‘bundle’. Given finite healthcare budgets, decisions about the optimal infection control policy require consideration of the effectiveness and value for money of each approach.\ud
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Objectives:\ud
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The aim of this research is to use a rational economic framework to inform efficient infection control policy relating to the prevention of CR-BSI in the intensive care unit. It addresses three questions relating to decision-making in this area:\ud
1. Is additional investment in activities aimed at preventing CR-BSI an efficient use of healthcare resources?\ud
2. What is the optimal infection control strategy from amongst the two major approaches that have been proposed to prevent CR-BSI?\ud
3. What uncertainty is there in this decision and can a research agenda to improve decision-making in this area be identified? \ud
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Methods: \ud
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A decision analytic model-based economic evaluation was undertaken to identify an efficient approach to preventing CR-BSI in Queensland Health intensive care units. A Markov model was developed in conjunction with a panel of clinical experts which described the epidemiology and prognosis of CR-BSI. The model was parameterised using data systematically identified from the published literature and extracted from routine databases. The quality of data used in the model and its validity to clinical experts and sensitivity to modelling assumptions was assessed. \ud
Two separate economic evaluations were conducted. The first evaluation compared all commercially available A-CVCs alongside uncoated catheters to identify which was cost-effective for routine use. The uncertainty in this decision was estimated along with the value of collecting further information to inform the decision. The second evaluation compared the use of A-CVCs to a catheter care bundle. We were unable to estimate the cost of the bundle because it is unclear what the full resource requirements are for its implementation, and what the value of these would be in an Australian context. As such we undertook a threshold analysis to identify the cost and effectiveness thresholds at which a hypothetical bundle would dominate the use of A-CVCs under various clinical scenarios.\ud
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Results: \ud
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In the first evaluation of A-CVCs, the findings from the baseline analysis, in which uncertainty is not considered, show that the use of any of the four A-CVCs will result in health gains accompanied by cost-savings. The MR catheters dominate the baseline analysis generating 1.64 QALYs and cost-savings of 948 per catheter) relative to all other catheter types. This conclusion was robust to all scenarios tested, however, the probability of error in this conclusion is high, 62% in the baseline scenario.\ud
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Using a value of 7.3 million. An analysis of the expected value of perfect information for individual parameters suggests that it may be worthwhile for future research to focus on providing better estimates of the mortality attributable to CR-BSI and the effectiveness of both SPC and CH/SSD (int/ext) catheters.\ud
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In the second evaluation of the catheter care bundle relative to A-CVCs, the results which do not consider uncertainty indicate that a bundle must achieve a relative risk of CR-BSI of at least 0.45 to be cost-effective relative to MR catheters. If the bundle can reduce rates of infection from 2.5% to effectively zero, it is cost-effective relative to MR catheters if national implementation costs are less than 56,610 per ICU). If the bundle can achieve a relative risk of 0.34 (comparable to that reported in the literature) it is cost-effective, relative to MR catheters, if costs over an 18 month period are below 13,343 per ICU).\ud
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Once uncertainty in the decision is considered, the cost threshold for the bundle increases to 47,826 each, this approach would be cost effective relative to A-CVCs. However, the uncertainty is substantial and the probability of error in concluding that the bundle is the cost-effective approach at a cost of 2.2 million is 89%. \ud
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Conclusions:\ud
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This work highlights that infection control to prevent CR-BSI is an efficient use of healthcare resources in the Australian context. If there is no further investment in infection control, an opportunity cost is incurred, which is the potential for a more efficient healthcare system. Minocycline/rifampicin catheters are the optimal choice of antimicrobial catheter for routine use in Australian Level III ICUs, however, if a catheter care bundle implemented in Australia was as effective as those used in the large studies in the United States it would be preferred over the catheters if it was able to be implemented for less than 47,826 per Level III ICU.\ud
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Uncertainty is very high in this decision and arises from multiple sources. There are likely greater costs to this uncertainty for A-CVCs, which may carry hidden costs, than there are for a catheter care bundle, which is more likely to provide indirect benefits to clinical practice and patient safety. Research into the mortality attributable to CR-BSI, the effectiveness of SPC and CH/SSD (int/ext) catheters and the cost and effectiveness of a catheter care bundle in Australia should be prioritised to reduce uncertainty in this decision.\ud
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This thesis provides the economic evidence to inform one area of infection control, but there are many other infection control decisions for which information about the cost-effectiveness of competing interventions does not exist. This work highlights some of the challenges and benefits to generating and using economic evidence for infection control decision-making and provides support for commissioning more research into the cost-effectiveness of infection control
Economics and preventing healthcare acquired infection
No full textThe evolution of organisms that cause healthcare acquired infections (HAI) puts extra stress on hospitals already struggling with rising costs and demands for greater productivity and cost containment. Infection control can save scarce resources, lives, and possibly a facility’s reputation, but statistics and epidemiology are not always sufficient to make the case for the added expense. Economics and Preventing Healthcare Acquired Infection presents a rigorous analytic framework for dealing with this increasingly serious problem. ----- \ud
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Engagingly written for the economics non-specialist, and brimming with tables, charts, and case examples, the book lays out the concepts of economic analysis in clear, real-world terms so that infection control professionals or infection preventionists will gain competence in developing analyses of their own, and be confident in the arguments they present to decision-makers. The authors: -----\ud
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Ground the reader in the basic principles and language of economics. -----\ud
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Explain the role of health economists in general and in terms of infection prevention and control. -----\ud
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Introduce the concept of economic appraisal, showing how to frame the problem, evaluate and use data, and account for uncertainty. -----\ud
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Review methods of estimating and interpreting the costs and health benefits of HAI control programs and prevention methods. -----\ud
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Walk the reader through a published economic appraisal of an infection reduction program. -----\ud
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Identify current and emerging applications of economics in infection control. ----\ud
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Economics and Preventing Healthcare Acquired Infection is a unique resource for practitioners and researchers in infection prevention, control and healthcare economics. It offers valuable alternate perspective for professionals in health services research, healthcare epidemiology, healthcare management, and hospital administration. -----\ud
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Written for:\ud
Professionals and researchers in infection control, health services research, hospital epidemiology, healthcare economics, healthcare management, hospital administration; Association of Professionals in Infection Control (APIC), Society for Healthcare Epidemiologists of America (SHEA)\u
Using economic data to reduce healthcare-acquired infection
No full textIn this issue Burns et al. report an estimate of the economic loss to Auckland City Hospital from cases of healthcare-associated bloodstream infection. They show that patients with infection stay longer in hospital and this must impose an opportunity cost because beds are blocked. Harder to measure costs fall on patients, their families and non-acute health services. Patients face some risk of dying from the infection
Economics and preventing hospital-acquired infection: Broadening the perspective
Full text linkObjective. To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs. Design. We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years. Setting. Hypothetical modeling to incorporate the societal perspective. Subjects. A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement. Intervention(s). A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement. Results and Conclusions. We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade -off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources
In Response: "Oral versus IV treatment for catheter-related bloodstream infections - by Burke A. Cunha"
No full textIn his letter Cunha suggests that oral antibiotic therapy is safer and less expensive than intravenous therapy via central venous catheters (CVCs) (1). The implication is that costs will fall and increased health benefits will be enjoyed resulting in a gain in efficiency within the healthcare system. CVCs are often used in critically ill patients to deliver antimicrobial therapy, but expose patients to a risk of catheter-related bloodstream infection (CRBSI). Our current knowledge about the efficiency (i.e. costeffectiveness) of allocating resources toward interventions that prevent CRBSI in patients requiring a CVC has already been reviewed (2). If for some patient groups antimicrobial therapy can be delivered orally, instead of through a CVC, then the costs and benefits of this alternate strategy should be evaluated..
Humans, ‘things’ and space : costing hospital infection control interventions
No full textBackground: Previous attempts at costing infection control programmes have tended to focus on accounting costs rather than economic costs. For studies using economic costs, estimates tend to be quite crude and probably underestimate the true cost. One of the largest costs of any intervention is staff time, but this cost is difficult to quantify and has been largely ignored in previous attempts.\ud
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Aim: To design and evaluate the costs of hospital-based infection control interventions or programmes. This article also discusses several issues to consider when costing interventions, and suggests strategies for overcoming these issues.\ud
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Methods: Previous literature and techniques in both health economics and psychology are reviewed and synthesized.\ud
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Findings: This article provides a set of generic, transferable costing guidelines. Key principles such as definition of study scope and focus on large costs, as well as pitfalls (e.g. overconfidence and uncertainty), are discussed.\ud
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Conclusion: These new guidelines can be used by hospital staff and other researchers to cost their infection control programmes and interventions more accurately
Catheter-related bloodstream infections in intensive care units: A systematic review with meta-analysis
No full textAim: This paper is a report of a systematic review and meta-analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter-related bloodstream infections and catheter colonization in the intensive care unit setting.---\ud
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Background: Catheter-related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter-related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes.---\ud
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Methods: A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords 'catheterization – central venous' with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter-related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta-analyses.---\ud
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Results: Twenty-three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter-related bloodstream infection included staff education multifaceted infection control programmes and performance feedback.---\ud
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Conclusion: A range of interventions may reduce risks of catheter-related bloodstream infection, in addition to antimicrobial catheters.\ud
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Emerg Infect Dis
Full text linkCatheter-related bloodstream infections are a serious problem. Many interventions reduce risk, and some have been evaluated in cost-effectiveness studies. We review the usefulness and quality of these economic studies. Evidence is incomplete, and data required to inform a coherent policy are missing. The cost-effectiveness studies are characterized by a lack of transparency, short time-horizons, and narrow economic perspectives. Data quality is low for some important model parameters. Authors of future economic evaluations should aim to model the complete policy and not just single interventions. They should be rigorous in developing the structure of the economic model, include all relevant economic outcomes, use a systematic approach for selecting data sources for model parameters, and propagate the effect of uncertainty in model parameters on conclusions. This will inform future data collection and improve our understanding of the economics of preventing these infections
Opportunity cost of unavailable surgical instruments in Australian hospitals
No full textHospitals invest considerable resources organizing operating suites and having surgeons and theatre staff available on an agreed schedule. A common impediment to efficiency is perioperative delay,including delays getting to the operating room or during the operation. Perioperative delays entail significant costs for hospitals,wasting staff time and operating theatre resources. They may also affect patient outcomes; prolonged surgery is a predictor for unanticipated admission following elective ambulatory surgery..
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