Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia

PLoS One. 2016 Feb 9;11(2):e0148190. doi: 10.1371/journal.pone.0148190. eCollection 2016.

Abstract

Background: The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.

Methods: The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012.

Findings: No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.

Conclusions: The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteremia / prevention & control*
  • Cost-Benefit Analysis*
  • Guideline Adherence / economics*
  • Guideline Adherence / statistics & numerical data
  • Hand Hygiene / statistics & numerical data*
  • Humans
  • Infection Control / economics*
  • Models, Statistical
  • Outcome Assessment, Health Care
  • Risk
  • Staphylococcal Infections / prevention & control*
  • Staphylococcus aureus / physiology*

Grants and funding

Financial support for this study was provided by a National Health and Medical Research Council Partnership grant (number 553081) with financial and in-kind support from Australian Commission on Safety and Quality in Health Care, Hand Hygiene Australia, and jurisdictional health departments. Representatives of the Australian Commission on Safety and Quality in Health Care attended research governance meetings to provide feedback on the progress of the project, but the design and conduct is the sole responsibility of the investigators awarded the grant. The funders had no veto on study design, data collection and analysis, decision to publish, or preparation of the manuscript.