Systematic review of economic analyses in patient safety: a protocol designed to measure development in the scope and quality of evidence

Estimating the savings of a national project to prevent healthcare-associated infections in intensive care units

BACKGROUND

Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate.

AIM

To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach.

METHODS

A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative.

RESULTS

The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%.

CONCLUSION

Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.

Value of improving patient safety: health economic considerations for rapid response systems-a rapid review of the literature and expert round table

OBJECTIVES

Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.

DESIGN

We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.

RESULTS

Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients' home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.

CONCLUSION

In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital.

An analysis of the effectiveness outcomes of economic studies evaluating ophthalmic drugs: a systematic review

PURPOSE

To characterize the effectiveness measures of cost-effectiveness studies (CES) of ophthalmic drugs.

METHODS

A systematic review was conducted in PubMed/Embase until October 2019. Cost-effectiveness studies (CES) evaluating ophthalmic drugs were included. Sources of effectiveness measures were extracted. Data on study design and study outcomes were extracted from sources of effectiveness measures. The adequacy of the sample size of the clinical studies used as sources of effectiveness measures was assessed. If CES have retrieved effectiveness data from multiple sources, the appropriateness of the method to combine the results was analysed.

RESULTS

Forty-five CES were included. Thirty-one (68.9%) retrieved their effectiveness measures from experimental studies, five (11.1%) from observational studies and nine (20%) from other type of data sources. Eight (17.8%) CES used data from a primary outcome of a study as an effectiveness measure, eight (17.8%) used data from secondary outcomes, seven (15.6%) used data from the both primary and secondary outcomes and for 22 (48.9%) it was not possible to identify the outcomes used. From the 23 (51.1%) CES based on a single clinical study, three (6.7%) included data from clinical studies which had an adequate sample size to detect significant differences in the clinical outcomes used as effectiveness measures. From the 17 (37.8%) CES based on multiple clinical studies, only one (2.2%) used and/or reported an adequate method of quantitative synthesis (meta-analysis).

CONCLUSION

A considerable number of CES in ophthalmology were not based on clinical studies with adequate sample sizes and report results from effectiveness measures not assessed as primary outcomes.

A systematic review of the methodological quality of economic studies evaluating ophthalmic drugs

INTRODUCTION

Innovative drugs have been approved in ophthalmology. Thus, the number and importance of economic evaluation studies of ophthalmic drugs have been growing. This study aims to assess the methodological quality of pharmacoeconomic studies of ophthalmic drugs.

AREAS COVERED

A systematic search was conducted in Pubmed/Embase until November 2018 to identify full pharmacoeconomic studies evaluating ophthalmic drugs. The quality of studies was evaluated using the British Medical Journal (BMJ) checklist. Quality indicators were evaluated by Fisher's exact test. Ninety-five studies were included, 50 (52.6%) cost-utility analysis, 28 (29.5%) cost-effectiveness and 17 (17.9%) cost-effectiveness/cost-utility. All studies presented, at least, three methodological limitations. Cost-utility studies, studies conducted from a health system perspective, with time horizons longer than one-year and that rely on observational or observational and experimental data simultaneously are associated with higher quality. Only eight (8.4%) studies considered two eyes in the economic analysis and only 13 (13.7%) considered the natural history of the disease when extrapolating results for long-term analysis.

EXPERT OPINION

The majority of the pharmacoeconomic studies were assessed as having good methodological quality, however, the methodological quality scores were sensitive to several indicators. Therefore, improving the quality of studies would enhance their usefulness in the decision-making processes.