Jabbar Sneha Abdul, Frödin Maria, Wikström Ewa, Gillespie Brigid M, Gyllensten Hanna, Erichsen Annette
Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden.
Institute of Health and Care Sciences, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden.
Antimicrob Resist Infect Control. 2025 Jul 3;14(1):80. doi: 10.1186/s13756-025-01573-y.
A theory-driven knowledge translation program was established to co-create and implement evidence-based practices to prevent urinary catheter-associated urinary tract infections (UC-UTIs) and bladder distension (BD). This study investigates the cost-effectiveness of implementing the Safe Hands and Safe Bladder bundle intervention compared to standard care for patients undergoing hip fracture surgery in Sweden.
The study included outcomes from a quality register of patients who underwent hip fracture surgery at a Swedish hospital from 2015 to 2020. Adopting a healthcare perspective, estimates for the implementation cost were derived using activity-based costing, while the bundle's cost-effectiveness was estimated using a decision tree model. Health outcomes were evaluated based on adverse events, specifically UC-UTI and BD. Analyses included calculating the incremental cost-effectiveness ratio (ICER), which denotes the incremental cost per added infection rate expressed as a percentage. Additionally, sensitivity analyses were conducted to test the robustness of the results under alternative cost assumptions.
The likelihood of avoiding BD or UC-UTI increased from 50 to 87% over the course of the intervention year. The discounted implementation cost was SEK 890,389 (corresponding to Int$ 102,721). However, the implementation cost was offset by costs for a prolonged hospital stay due to these adverse events, resulting in an overall cost savings of SEK - 7,334 per patient (Int$ -846) in 2020 compared to before the intervention was introduced. Consequently, the intervention proved to be cost-effective, leading to savings and a decrease in the occurrence of adverse events.
Implementing the bundle intervention in units providing care for patients with acute hip fractures proved cost-effective. This offers decision makers valuable insights and demonstrates that implementation programs incorporating collaboration, facilitation and co-creation processes can effectively use limited resources. Further research should determine the generalizability of the findings to other settings and populations.
NCT02983136 and ISRCTN 17,022,695, retrospectively registered after data collection were completed.
建立了一个理论驱动的知识转化项目，以共同创造并实施基于证据的实践方法，预防导尿管相关尿路感染（UC-UTIs）和膀胱扩张（BD）。本研究调查了在瑞典，与髋部骨折手术患者的标准护理相比，实施“安全手部与安全膀胱”捆绑式干预措施的成本效益。
该研究纳入了2015年至2020年在瑞典一家医院接受髋部骨折手术患者的质量登记结果。从医疗保健角度出发，采用基于活动的成本核算方法得出实施成本估算值，同时使用决策树模型估算捆绑式干预措施的成本效益。基于不良事件，特别是UC-UTI和BD来评估健康结果。分析包括计算增量成本效益比（ICER），即每增加一个感染率的增量成本，以百分比表示。此外，还进行了敏感性分析，以测试在替代成本假设下结果的稳健性。
在干预年期间，避免发生BD或UC-UTI的可能性从50%提高到了87%。贴现后的实施成本为890,389瑞典克朗（相当于102,721国际美元）。然而，由于这些不良事件导致住院时间延长所产生的成本抵消了实施成本，与引入干预措施之前相比，2020年每位患者总体节省成本7,334瑞典克朗（-846国际美元）。因此，该干预措施被证明具有成本效益，既能节省成本，又能减少不良事件的发生。
在为急性髋部骨折患者提供护理的科室实施捆绑式干预措施被证明具有成本效益。这为决策者提供了有价值的见解，并表明纳入协作、促进和共同创造过程的实施项目可以有效利用有限资源。进一步的研究应确定这些研究结果在其他环境和人群中的可推广性。
NCT02983136和ISRCTN 17,022,695，在数据收集完成后进行回顾性注册。
