Healey Andy, Søfteland Eirik, Harthug Stig, Haaverstad Rune, Mahesparan Rupavathana, Hjallen Bjørg Merete, Eide Geir Egil, Sevdalis Nick, Haugen Arvid Steinar
Center for Implementation Science, Health Service, and Population Research Department, King's College London, London, United Kingdom.
King's Health Economics, Health Service, and Population Research Department, King's College London, London United Kingdom.
Ann Surg. 2022 Apr 1;275(4):679-684. doi: 10.1097/SLA.0000000000004300.
To evaluate cost-effectiveness of the WHO Surgical Safety Checklist.
The clinical effectiveness of surgical checklists is largely understood. Few studies to-date have evaluated the cost-effectiveness of checklist use.
An economic evaluation was carried out using data from the only available randomized controlled trial of the checklist. Analyses were based on 3702 procedures. Costs considered included checklist implementation costs and length and cost of hospital stay, costs of warming blanket use, blood transfusions and antibiotics used in the operating room, and the cost of clinical time in the operating room - all calculated for each procedure and its associated admission. Nonparametric bootstrapping was used to simulate an empirical distribution of the mean effect of the checklist on total admission costs and the probability of observing a complication-free admission and to quantify sampling uncertainty around mean cost estimates.
The overall cost of checklist implementation was calculated to be $900 per 100 admissions. Implementation of the WHO checklist resulted in an additional 5.9 complication-free admissions per 100 admissions and an average of 110 bed-days saved per 100 admissions. Accounting for all costs included in the analysis, for every 100 admissions, use of the WHO checklist was estimated to save $55,899.
Implementation of the WHO checklist was a cost-effective strategy for improving surgical safety.
评估世界卫生组织手术安全核对表的成本效益。
手术核对表的临床有效性已基本明确。迄今为止，很少有研究评估使用核对表的成本效益。
利用该核对表唯一可用的随机对照试验数据进行经济评估。分析基于3702例手术。所考虑的成本包括核对表实施成本、住院时间和费用、保温毯使用成本、输血成本、手术室使用的抗生素成本以及手术室临床时间成本——所有这些均针对每个手术及其相关住院情况进行计算。采用非参数自抽样法模拟核对表对总住院成本的平均影响以及无并发症住院概率的经验分布，并量化平均成本估计值周围的抽样不确定性。
核对表实施的总成本经计算为每100例住院900美元。实施世界卫生组织核对表后，每100例住院中无并发症住院病例增加5.9例，每100例住院平均节省110个床位日。考虑到分析中包含的所有成本，估计每100例住院使用世界卫生组织核对表可节省55,899美元。
实施世界卫生组织核对表是提高手术安全性的一种具有成本效益的策略。
