Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

Abstract

BackgroundThe objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.MethodsThe design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012.FindingsNo useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.ConclusionsThe Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.

Make economics your friend

“…People are the staff required to make the change happen and are usually an important component of infection prevention programmes. Approximately 90% of the annual costs of running the Australian National Hand Hygiene initiative were for staff time on auditing, reporting data, running education and coordinating activities by attending meetings [10,11]. 'Things' might include consumable items or capital equipment, and the extent to which they drive costs of separate programmes will vary.…”

“…This method was used for an evaluation of the Australian National Hand Hygiene programme that used healthcareassociated Staphylococcus aureus bacteraemia as the outcome [10]. Table III shows that for Queensland and the Australian Capital Territory, the probability that a decision to adopt would be cost-effective was 100%.…”

“…In ACT there is a 41% probability that the programme was cost-saving. a Data reproduced from Graves et al [10]. b Mean (95% uncertainty intervals).…”

Determining the ideal prevention strategy for multidrug-resistance organisms in resource-limited countries: a cost-effectiveness analysis study

“…Health economic analysis is a useful tool to evaluate the effect of various health policies and is being increasingly used in the analysis of the prevention and control measures of MDROs [15][16][17]. Previous studies have mainly focused on a single measure evaluation in developed countries [18][19][20][21], but did not consider the most cost-effective isolation measures with regard to limited health resources.…”

Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis

“…Hand hygiene interventions should also reduce other types of MRSA infections and infections with other organisms. However, since these are harder to quantify, we take a conservative approach by focusing on MRSA-BSI alone and are therefore likely to underestimate the true health benefits of the intervention [20] .…”