De Jager P, Zungu M, Dyers R E
Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Social Policy, London School of Economics and Political Science, London, UK.
S Afr Med J. 2018 May 25;108(6):477-483. doi: 10.7196/SAMJ.2018.v108i6.12913.
Healthcare workers (HCWs) are at increased risk of contracting various communicable diseases. Needlestick injuries (NSIs) are a common mechanism of exposure. Training in basic universal precautions and utilisation of safety-engineered devices (SEDs) are interventions known to reduce the risk of NSI.
To assess the cost-utility of SEDs v. a training programme in universal precautions (TP) v. a combination strategy to reduce NSIs among South African HCWs.
A Markov model comparing SEDs v. a TP v. a combination strategy against current practice was developed. A hypothetical cohort of HCWs working in the SA public sector was followed from a payer's perspective for a period of 45 years, and discounted costs and benefits were assessed. Data were obtained from the National Department of Health, suppliers and published literature. One-way and probabilistic sensitivity analysis was conducted.
Over the study time horizon, our model estimated that 2 209, 3 314 and 4 349 needlestick injuries per 1 000 HCWs could be prevented if a TP, SEDs or a combination strategy, respectively, was adopted compared with current practice. All three candidate interventions were cost-effective at a willingness to pay (WTP) of one times the gross domestic product per capita (USD6 483.90/quality-adjusted life-year (QUALY) gained). SEDs as a stand-alone intervention was dominated by a combination strategy. Compared with current practice, the incremental cost-effectiveness of training was USD32.90/QALY v. USD432.32/QALY for SEDs and USD377.08/QALY for a combination strategy. Results were sensitive to the effectiveness of the interventions. Probabilistic sensitivity analysis showed that at a WTP of USD6 483.90/QALY gained, a combination strategy would be cost-effective 95.4% of the time.
A combination strategy in which both SEDs and a TP are adopted is preferred.
医护人员感染各种传染病的风险增加。针刺伤是常见的暴露途径。基本通用预防措施培训和使用安全工程设备是已知可降低针刺伤风险的干预措施。
评估安全工程设备、通用预防措施培训计划以及组合策略在降低南非医护人员针刺伤风险方面的成本效益。
建立了一个马尔可夫模型，比较安全工程设备、通用预防措施培训计划和组合策略与当前做法。从支付者的角度对南非公共部门工作的一组假设医护人员队列进行了为期45年的跟踪，并评估了贴现成本和效益。数据来自国家卫生部、供应商和已发表的文献。进行了单向和概率敏感性分析。
在研究期间，我们的模型估计，与当前做法相比，如果分别采用通用预防措施培训计划、安全工程设备或组合策略，每1000名医护人员中可预防2209例、3314例和4349例针刺伤。在支付意愿为人均国内生产总值一倍（每获得一个质量调整生命年6483.90美元）的情况下，所有三种候选干预措施都具有成本效益。安全工程设备作为单一干预措施被组合策略所主导。与当前做法相比，培训的增量成本效益为每质量调整生命年32.90美元，安全工程设备为每质量调整生命年432.32美元，组合策略为每质量调整生命年377.08美元。结果对干预措施的有效性敏感。概率敏感性分析表明，在每获得一个质量调整生命年支付意愿为6483.90美元的情况下，组合策略在95.4%的时间内具有成本效益。
采用安全工程设备和通用预防措施培训计划的组合策略是首选。
