Course Access
Hi Ruth,
Dollars per life-year saved is a pretty standard measure of
cost-effectiveness in health economics.
If you think about what we do in healthcare in terms of economics and
patient outcomes, it can either save money or cost money and can either
save lives/reduce disease or kill people / increase disease.
Things that save money and save lives are no-brainers.
Things that cost money and reduce health are obviously stupid ideas.
The tricky issue is assessing interventions that cost money but improve
health, or (to a lesser extent) save money but are less-good in terms of
health outcomes.
If you have an intervention that prevents 1000 deaths but costs a billion
dollars, you need to consider all of the other things you could do with
that billion dollars and if together, you could prevent more than 1000
deaths by doing them instead, and dollars-per-life-year-saved is one of the
ways of measuring that.
You can read more:
https://en.wikipedia.org/wiki/Cost-effectiveness_analysis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497852/
http://www.who.int/choice/publications/p_2003_generalised_cea.pdf
(and around $20,000 per life-year saved is a common threshold for
cost-effective care, depending on the circumstances)
Regards,
Trent.
—
Trent Yarwood
trentyarwood@gmail.com
On 24 March 2016 at 09:35, Ruth Ryburn wrote:
> Good morning,
>
>
>
> I have read the discussion around this issue and publication with
> interest but limited understanding.
>
> Would someone please be able to explain in simple terms the phrase:
>
>
>
> *.changed from $29,700 per life year gained to $25,094 per life year
> gained.*
>
>
>
> Thank you,
>
>
>
> *Ruth Ryburn*
>
> *Infection Control Coordinator*
>
>
>
> *[image: DPH_logo]*
>
> *58 Quirk Street*
>
> *Dee Why, NSW 2099*
>
> *T: (02) 8978 5276 *
>
> *F: (02) 9971 7299 *
>
> *M: 0414 801 660 *
>
>
>
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>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Michael Wishart
> *Sent:* Monday, 21 March 2016 3:04 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> [Posted on behalf of the original authors Moderator}
>
>
>
> As the University based authors of this paper, we also welcome this
> discussion. It was a challenging and difficult study but that made it
> interesting. With almost $1M of funding from the NHMRC and ACSQHC we felt a
> large responsibility to do the best possible study. We have no prior
> position or biases about the value of the NHHI.
>
>
>
> In response to the specific points raised by Lindsay and Andrew:
>
>
>
> o When we halved the costs of running Hand Hygiene Australia (HHA) the
> main result changed from $29,700 per life year gained to $25,094 per life
> year gained
>
> o When we additionally reduced the estimated time spent on audits by
> hand hygiene auditors by 50% the main result changed from $25,094 per life
> year gained to $18,960 per life year gained.
>
> o *S. aureus* bloodstream infections were chosen as the outcome measure
> by the steering committee for the project, and the reasoning was sound. The
> data are reliable for the states and territories, SAB is very expensive to
> treat and has large mortality risk. It is likely the best outcome measure
> to demonstrate the cost-effectiveness of the NHHI.
>
> o We did an analysis of other infection outcomes that showed a
> statistically significant reduction in 11/23 infection rates, no change for
> 9/23 and increases for 3/23. Here is the paper
> http://www.publish.csiro.au/?paperHI14033
>
> o Including quality of life changes had a negligible impact on the
> results.
>
> o We responded to Lindsays letter in JHI here
> http://www.ncbi.nlm.nih.gov/pubmed/25555834
>
>
>
> Estimating the value for money of infection prevention programmes is
> important, particularly in todays climate where funding is tight. This
> situation of scarce resources is likely to be the new normal for health
> services.
>
>
>
> Our study, and the interest in it, highlights the need for evaluations to
> inform policy decisions. As a community we should take every opportunity to
> build a culture of evidence-based policy. We are obliged to prefer health
> programmes that deliver good value for money.
>
>
>
> Prof Nick Graves, on behalf of the authors
>
>
>
> [This post added for continuity Moderator}
>
>
>
> [Posted on behalf of HHA – Moderator]
>
> We welcome discussion regarding this paper, and more broadly of the
> National Hand Hygiene Initiative. The QUT study was a large and complex
> project with many issues that warrant discussion and comment. Some of our
> comments have been previously published (see Grayson ML. J Hosp Infect
> 89: 137 ). Wed like to
> contribute the following points to todays discussion on this list:
>
>
>
> – The annual cost of the NHHI as assessed by this study reflects
> start-up rather than maintenance costs. The cost information used in
> this study is taken from the 2011-2012 financial year (Page *et al*. J
> Hosp Infect, 2014;88:141). HHAs budget, which represented 20% of the NHHI
> costs, was halved in the subsequent financial year of 2012-13 (on schedule)
> and has since remained at this lower level.
>
>
>
> – Other changes have been made as this program matured. For example,
> the costing study pre-dates introduction of the HHCApp mobile tool. This
> was developed to reduce total auditing time requirements (by elimination of
> data entry), while also facilitating immediate feedback and minimising data
> entry errors. Surveyed hand hygiene auditors that have moved to mobile
> devices have estimated that this can reduce time spent on audits by up to
> 50% (we aim to publish). So the cost-effectiveness study no longer reflects
> current practice.
>
>
>
> – The benefits of the NHHI are almost certainly under-estimated. This
> study only considered health and cost benefits of preventing one type of
> HAI: *S. aureus* bloodstream infections. This is because no national
> measures were available for other infection types or pathogens. But
> appropriate hand hygiene should have broader benefits, not only for other
> healthcare-associated infections but also to reduce the transmission of
> antimicrobial resistance. No assessment of patient suffering was included.
>
>
>
> Despite these points, the summary finding of this QUT study was that the
> NHHI is cost-effective according to Australian standards: This is the
> first cost-effectiveness evaluation of a National Hand Hygiene Initiative
> and shows that overall the programme was cost effective with a cost per
> life year gained of $29,700.
>
>
>
> The NHHI is unique both in Australia and globally. We believe that its
> successes have been the result of combining evidence-based interventions
> and strong collaboration between infection control professionals,
> jurisdictional authorities, HHA, the Australian Commission on Safety and
> Quality in Health Care, and other groups. But just as the program has
> evolved since the 2012 snapshot provided by this study, it should also
> continue to do so into the future. This discussion is one part of that
> process.
>
>
>
> Andrew Stewardson, National Project Manager, Hand Hygiene Australia
>
> Lindsay Grayson, Director, Hand Hygiene Australia
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Michelle Bibby
> *Sent:* Friday, 26 February 2016 12:26 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Thank you Mary-Louise for your response re Graves et al study and the
> variances.
>
>
>
> The concerns of biased data reported for hand hygiene compliance is worth
> noting and I too agree with your comments here.
>
>
>
> Costs associated with the efforts to report HH data as required which
> detracts from some of the critical day to day requirements of the IC nurse
> need further review.
>
>
>
> Thank you
>
> Michelle
>
>
>
> Michelle Bibby
>
> Infection Prevention Australia
>
> Michelle@infectionprevention.com.au
>
> +429071165
>
>
>
>
>
> *From: *MaryLouise McLaws
> *Reply-To: *ACIPC Infexion Connexion
> *Date: *Thu, 25 Feb 2016 23:24:28 +0000
> *To: *
> *Subject: *Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
>
>
> Dear Ramon and Glenys
>
>
>
> Graves et al study relies on the accuracy of the 2 pivotal variables: SAB
> and hand hygiene compliance. The accuracy of the latter is serious
> limited. Our report in the Medical Journal of Australia (*Med J Aust* 2014;
> 200 (9):534-537. http://dx.doi.org/10.5694/mja13.11203) concluded the HHA
> program reports rates that have been biased upwards by *very few high
> performers*.
>
>
>
> The conclusion from our findings and Graves et al is:
>
>
>
> (1) SAB respond to multiple interventions and hand hygiene is only one of
> these.
>
> (2) hygiene compliance rates have not reached a tipping point to reduce
> SAB and this tipping point is a long way off because
>
> (3) the hand hygiene compliance rates are inaccurate.
>
>
>
>
>
> *It is important to have a national HH program*. But the expense of the
> current program is too high when the cost of audits provides flawed data
> that reinforces a misguided belief that our hospitals are performing HH
> well.
>
>
>
>
>
> Mary-Louise
>
> *Professor Mary-Louise McLaws*
>
> *Professor of Epidemiology in Healthcare Infection and Infectious Diseases
> Control *
>
> http://research.unsw.edu.au/people/professor-marylouise-mclaws
>
> SPHCM SAMUELS BUILDING
>
> UNSW AUSTRALIA, SYDNEY NSW 2052 AUSTRALIA
>
> Telephone: (+612) 9385 2586 FaX: (+612) 93136185
>
> CRICOS Provider Code 00098G
>
>
>
>
> ——————————
>
> *From:* ACIPC Infexion Connexion [AICALIST@AICALIST.ORG.AU] on behalf of
> Professor Ramon Shaban, ACIPC President [president@ACIPC.ORG.AU]
> *Sent:* Friday, 26 February 2016 09:10
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: FW: Hand Hygiene Aistralia – Cost effectiveness publication
>
> Colleagues
>
>
>
> The study by Graves et al. reports a range of interesting findings, and
> raises many issues regarding hand hygiene for broader consideration. The
> College is examining the paper and is preparing a media release for release
> in the coming days.
>
>
>
> Kind regards,
>
> Ramon
>
>
>
>
> *Professor Ramon Z Shaban PRESIDENT*
>
> Australasian College for Infection Prevention and Control
>
> GPO Box 3254, Brisbane Qld 4001
> Tel: +61 7 3735 6463 Mobile: 0478 312 668
>
> Email: president@acipc.org.au
>
> Web: https://www.acipc.org.au
>
>
>
> On 25 February 2016 at 21:16, Glenys Harrington
> wrote:
>
> Dear All,
>
>
>
> Find attached the following publication (February 9, 2016).
>
>
>
> *Graves et al. Cost-Effectiveness of a National Initiative to
> Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated
> Staphylococcus aureus Bacteraemia. PLoS ONE 11(2): e0148190.
> doi:10.1371/journal.*
>
>
>
> The analysis was undertaken on data from 6 Australian states:
>
>
>
> In 2/6 states there was a 1% chance it was cost effective
>
> In 1/6 states there was a 26% chance it was cost effective
>
> In 1/6 states there was a 80% chance it was cost effective and
>
> In 2/6 a 100% chance it was cost effective.
>
>
>
> Interesting figure showing cost increases and cost savings by state (fig
> 2).
>
>
>
> Also some interesting points in the discussion.
>
>
>
> Shame there was No useable pre-implementation data available for
> Victoria and hence was not able to be analysed.
>
>
>
> *Given the findings of the analysis it raises the following questions for
> governments:*
>
>
>
> *Shouldnt the program be scaled back and some of the money be
> spent on other initiatives to reduce hospitals associated infections(HAIs)?*
>
>
>
> * Shouldnt the program be scaled back to reduce the infection
> control workload associated with the program which is currently
> overwhelming and taking ICPs away from other core infection control
> activities?*
>
>
>
> *A press release by the College about the findings of this study and the
> views of the college in terms of the allocation of limited resources would
> be timely.*
>
>
>
>
>
> regards
>
>
>
> Glenys
>
>
>
> *Glenys Harrington*
>
> *Consultant*
>
> *Infection Control Consultancy (ICC)*
>
> *PO Box 5202*
>
> *Middle Park*
>
> *Victoria, 3206*
>
> *Australia*
>
> *M: +61 404 816 434 *
>
> *infexion@ozemail.com.au*
>
> *ABN 47533508426*
>
>
>
>
>
>
>
>
>
>
>
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