Leigh J Paul, Gillen Marion, Franks Peter, Sutherland Susan, Nguyen Hienh H, Steenland Kyle, Xing Guibo
Center for Healthcare Policy and Research and Department of Public Health Sciences, University of California, Davis, CA 95616-8638, USA.
Curr Med Res Opin. 2007 Sep;23(9):2093-105. doi: 10.1185/030079907X219517.
Physicians, nurses and other healthcare workers (HCWs) are at risk of bloodborne pathogens infection from needlestick injuries, but costs of needlesticks are little studied.
We used the cost-of-illness and incidence approaches. We used the perspective of the medical provider (medical costs) and the individual (lost productivity). Data on needlesticks, infections from hepatitis B and C (HBV, HCV) and human immune-deficiency (HIV) among HCWs, as well as data on per-unit costs were culled from research literature, Centers for Disease Control and Prevention reports, and Bureau of Labor Statistics reports. We also generated estimates based upon industry employment and scenarios for source-patients. These data and estimates were combined with assumptions to produce a model that generated base-case estimates as well as one-way and multi-way probabilistic sensitivity analyses. Future costs were discounted by 3%.
We estimated 644,963 needlesticks in the healthcare industry for 2004 of which 49% generated costs. Medical costs were $107.3 million of which 96% resulted from testing and prophylaxis and 4% from treating long-term infections (34 persons with chronic HBV, 143 with chronic HCV, and 1 with HIV). Lost-work productivity generated $81.2 million, for which 59% involved testing and prophylaxis and 41% involved long-term infections. Combined medical and work productivity costs summed to $188.5 million. Multi-way sensitivity analysis suggested a range on combined costs from $100.7 million to $405.9 million.
Detailed methodology was developed to estimate costs of needlesticks and subsequent infections for hospital-based and non-hospital-based health care workers. The combined medical and lost productivity costs comprised roughly 0.1% of all occupational injury and illness costs for all jobs in the economy. We did not account for lost home production or pain and suffering costs, however, nor did we estimate benefit/cost ratios of specific interventions to reduce needlesticks.
医生、护士及其他医护人员面临针刺伤导致血源性病原体感染的风险，但针刺伤的成本鲜少得到研究。
我们采用疾病成本法和发病率法。我们从医疗服务提供者（医疗成本）和个人（生产力损失）的角度进行考量。医护人员针刺伤、乙型和丙型肝炎（HBV、HCV）及人类免疫缺陷病毒（HIV）感染的数据，以及单位成本数据均摘自研究文献、疾病控制与预防中心报告及劳工统计局报告。我们还根据行业就业情况和源患者情景生成了估算值。这些数据和估算值与假设相结合，构建了一个模型，该模型生成了基础情况估算值以及单因素和多因素概率敏感性分析。未来成本按3%进行贴现。
我们估计2004年医疗行业发生了644,963次针刺伤，其中49%产生了成本。医疗成本为1.073亿美元，其中96%来自检测和预防，4%来自长期感染治疗（34例慢性HBV患者、143例慢性HCV患者和1例HIV患者）。生产力损失达8120万美元，其中59%涉及检测和预防，41%涉及长期感染。医疗成本与工作生产力成本总计1.885亿美元。多因素敏感性分析表明，总成本范围在1.007亿美元至4.059亿美元之间。
我们开发了详细的方法来估算医院和非医院医护人员针刺伤及后续感染的成本。医疗成本与生产力损失成本总计约占经济中所有工作的职业伤害和疾病总成本的0.1%。然而，我们未考虑家庭生产损失或痛苦成本，也未估算减少针刺伤的特定干预措施的效益/成本比。
