Department of Infectious Diseases, St. Marianna University, Kanagawa, Japan.
Healthcare to All Co. Ltd., Tokyo, Japan.
PLoS One. 2019 Nov 7;14(11):e0224142. doi: 10.1371/journal.pone.0224142. eCollection 2019.
Needlestick injury (NSI) is one of the most burdensome professional hazards in any medical setting; it can lead to transmission of fatal infectious diseases, such as hepatitis B, hepatitis C and human immunodeficiency virus. In the United States, the annual cost burden was estimated as somewhere between $118 million to $591 million; in the United Kingdom it is approximated to be £500,000 (US$919,117.65) per the National Health Service.
This is the first published paper on the national cost burden of NSIs in Japan. A systematic literature review was conducted to review previous study design in global studies and to extract parameter values from Japanese studies. We conducted abstract searches through PubMed and the Japan Medical Abstracts Society (Ichushi), together with grey literature and snowball searches. A simple economic model was developed to calculate cost burden of NSIs from a societal perspective over a one-year time horizon. We assumed all NSIs are reported and perfect adherence in post NSI management that presented in the labour compensation scheme. Local guidelines were also referenced to extract resource utilization. Lastly, a deterministic sensitivity analysis was conducted and a scenario analysis which considered a payer perspective was also included.
The national cost burden of in-hospital NSIs is estimated as ¥33.4 billion (US$302 million) annually, based on an average cost per NSI of ¥63,711 (US$577) and number of NSIs at 525,000/year. 70% of the cost is due to initial laboratory tests, followed by productivity loss, estimated at 20% of the total cost. Cost of contaminated NSIs remains at 5% of the total cost. Change in number of NSIs significantly influences outcomes. Variation in post-exposure management practices suggests a need for NSI specific National guidelines and holistic labour compensation scheme development in Japan.
针刺伤（NSI）是任何医疗环境中最具负担的职业危害之一；它可导致致命传染病的传播，如乙型肝炎、丙型肝炎和人类免疫缺陷病毒。在美国，每年的成本负担估计在 11800 万至 59100 万美元之间；在英国，国民保健制度估计为 50 万英镑（919117.65 美元）。
这是日本首次发表的关于 NSI 国家成本负担的论文。进行了系统的文献综述，以审查全球研究中的先前研究设计并从日本研究中提取参数值。我们通过 PubMed 和日本医学文摘协会（Ichushi）进行了摘要搜索，同时还进行了灰色文献和雪球搜索。从社会角度出发，我们开发了一个简单的经济模型，以计算一年时间内 NSI 的成本负担。我们假设所有 NSI 都报告了，并且在劳动补偿计划中提出的 NSI 管理后完全遵守。还参考了当地指南以提取资源利用情况。最后进行了确定性敏感性分析，并进行了考虑支付者视角的情景分析。
根据每例 NSI 平均成本为 63711 日元（577 美元）和每年发生 NSI 52.5 万例的假设，日本医院内 NSI 的全国成本负担估计为每年 334 亿日元（3020 万美元）。70%的成本归因于初始实验室检查，其次是生产力损失，估计占总成本的 20%。受污染的 NSI 的成本仍占总成本的 5%。NSI 数量的变化显著影响结果。暴露后管理实践的变化表明，日本需要制定专门的 NSI 国家指南和全面的劳动补偿计划。
