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Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England.

ABSTRACT: OBJECTIVES:To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England. DESIGN:A modelling study based on a combination of published data and clinical practice. SETTING:NHS hospitals in England. PRIMARY AND SECONDARY OUTCOME MEASURES:Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work. RESULTS:In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8?million adult inpatients in NHS general and teaching hospitals in England, of which 22?800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810?000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6?million occupied hospital bed days and 62?500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1?billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7?billion, and accounting for 28?500 patient deaths, 7.1?million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79?700 days of absenteeism among front-line HCPs. CONCLUSION:This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.

SUBMITTER: Guest JF

PROVIDER: S-EPMC7045184 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England.

Guest Julian F JF Keating Tomas T Gould Dinah D Wigglesworth Neil N

BMJ open 20200122 1

<h4>Objectives</h4>To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England.<h4>Design</h4>A modelling study based on a combination of published data and clinical practice.<h4>Setting</h4>NHS hospitals in England.<h4>Primary and secondary outcome measures</h4>Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from ...[more]

PMID: 31974088

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Project description:BACKGROUND: Dynamic transmission models are increasingly being used to improve our understanding of the epidemiology of healthcare-associated infections (HCAI). However, there has been no recent comprehensive review of this emerging field. This paper summarises how mathematical models have informed the field of HCAI and how methods have developed over time. METHODS: MEDLINE, EMBASE, Scopus, CINAHL plus and Global Health databases were systematically searched for dynamic mathematical models of HCAI transmission and/or the dynamics of antimicrobial resistance in healthcare settings. RESULTS: In total, 96 papers met the eligibility criteria. The main research themes considered were evaluation of infection control effectiveness (64%), variability in transmission routes (7%), the impact of movement patterns between healthcare institutes (5%), the development of antimicrobial resistance (3%), and strain competitiveness or co-colonisation with different strains (3%). Methicillin-resistant Staphylococcus aureus was the most commonly modelled HCAI (34%), followed by vancomycin resistant enterococci (16%). Other common HCAIs, e.g. Clostridum difficile, were rarely investigated (3%). Very few models have been published on HCAI from low or middle-income countries.The first HCAI model has looked at antimicrobial resistance in hospital settings using compartmental deterministic approaches. Stochastic models (which include the role of chance in the transmission process) are becoming increasingly common. Model calibration (inference of unknown parameters by fitting models to data) and sensitivity analysis are comparatively uncommon, occurring in 35% and 36% of studies respectively, but their application is increasing. Only 5% of models compared their predictions to external data. CONCLUSIONS: Transmission models have been used to understand complex systems and to predict the impact of control policies. Methods have generally improved, with an increased use of stochastic models, and more advanced methods for formal model fitting and sensitivity analyses. Insights gained from these models could be broadened to a wider range of pathogens and settings. Improvements in the availability of data and statistical methods could enhance the predictive ability of models.

Project description:ObjectivesThis feasibility study aimed to model in silico the current healthcare system for patients triaged to a primary care disposition following a call to National Health Service (NHS) 111 and determine the effect of reconfiguring the healthcare system to ensure a timely primary care service contact.DesignDiscrete event simulation.SettingSingle English NHS 111 call centre in Yorkshire.ParticipantsCallers registered with a Bradford general practitioner who contacted the NHS 111 service in 2021 and were triaged to a primary care disposition.Primary and secondary outcome measuresFace validity of conceptual model. Comparison between real and simulated data for quarterly counts (and 95% CIs) for patient contact with emergency ambulance (999), 111, and primary and secondary care services. Mean difference and 95% CIs in healthcare system usage between simulations and difference in mean proportion of avoidable admissions for callers who presented to an emergency department (ED).ResultsThe simulation of the current system estimated that there would be 39 283 (95% CI 39 237 to 39 328) primary care contacts, 2042 (95% CI 2032 to 2051) 999 calls and 1120 (95% CI 1114 to 1127) avoidable ED attendances. Modifying the model to ensure a timely primary care response resulted in a mean percentage increase of 196.1% (95% CI 192.2% to 199.9%) in primary care contacts, and a mean percentage decrease of 78.0% (95% CI 69.8% to 86.2%) in 999 calls and 88.1% (95% CI 81.7% to 94.5%) in ED attendances. Avoidable ED attendances reduced by a mean of -26 (95% CI -35 to -17).ConclusionIn this simulated study, ensuring timely contact with a primary care service would lead to a significant reduction in 999 and 111 calls, and ED attendances (although not avoidable ED attendance). However, this is likely to be impractical given the need to almost double current primary care service provision. Further economic and qualitative research is needed to determine whether this intervention would be cost-effective and acceptable to both patients and primary care clinicians.

Project description:ObjectiveTo assess implementation of the Saving Babies Lives (SBL) Care Bundle, a collection of practice recommendations in four key areas, to reduce stillbirth in England.DesignA retrospective cohort study of 463,630 births in 19 NHS Trusts in England using routinely collected electronic data supplemented with case note audit (n = 1,658), and surveys of service users (n = 2,085) and health care professionals (n = 1,064). The primary outcome was stillbirth rate. Outcome rates two years before and after the nominal SBL implementation date were derived as a measure of change over the implementation period. Data were collected on secondary outcomes and process outcomes which reflected implementation of the SBL care bundle.ResultsThe total stillbirth rate, declined from 4.2 to 3.4 per 1,000 births between the two time points (adjusted Relative Risk (aRR) 0.80, 95% Confidence Interval (95% CI) 0.70 to 0.91, P<0.001). There was a contemporaneous increase in induction of labour (aRR 1.20 (95%CI 1.18-1.21), p<0.001) and emergency Caesarean section (aRR 1.10 (95%CI 1.07-1.12), p<0.001). The number of ultrasound scans performed (aRR 1.25 (95%CI 1.21-1.28), p<0.001) and the proportion of small for gestational age infants detected (aRR 1.59 (95%CI 1.32-1.92), p<0.001) also increased. Organisations reporting higher levels of implementation had improvements in process measures in all elements of the care bundle. An economic analysis estimated the cost of implementing the care bundle at ~£140 per birth. However, neither the costs nor changes in outcomes could be definitively attributed to implementation of the SBL care bundle.ConclusionsImplementation of the SBL care bundle increased over time in the majority of sites. Implementation was associated with improvements in process outcomes. The reduction in stillbirth rates in participating sites exceeded that reported nationally in the same timeframe. The intervention should be refined to identify women who are most likely to benefit and minimise unwarranted intervention.Trial registrationThe study was registered on (NCT03231007); www.clinicaltrials.gov.

Project description:BACKGROUND: In contrast to other pregnancy complications the economic impact of stillbirth is poorly understood. We aimed to carry out a preliminary exploration of the healthcare costs of stillbirth from the time of pregnancy loss and the period afterwards; also to explore and include the impact of a previous stillbirth on the healthcare costs of the next pregnancy. METHODS: A structured review of the literature including cost studies and description of costs to health-care providers for care provided at the time of stillbirth and in a subsequent pregnancy. Costs in a subsequent pregnancy were compared in three alternative models of care for multiparous women developed from national guidelines and expert opinion: i) "low risk" women who had a live birth, ii) "high risk" women who had a live birth and iii) women with a previous stillbirth. RESULTS: The costs to the National Health Service (NHS) for investigation immediately following stillbirth ranged from £1,242 (core recommended investigations) to £1,804 (comprehensive investigation). The costs in the next pregnancy following a stillbirth ranged from £2,147 (low-risk woman with a previous healthy child) to £3,751 (Woman with a previous stillbirth of unknown cause). The cost in the next pregnancy following a stillbirth due to a known recurrent or an unknown cause is almost £500 greater than the pregnancy following a stillbirth due to a known non-recurrent cause. CONCLUSIONS: The study has highlighted the paucity of evidence regarding economic issues surrounding stillbirth. Women who have experienced a previous stillbirth are likely to utilise more health care services in their next pregnancy particularly where no cause is found. Every effort should be made to determine the cause of stillbirth to reduce the overall cost to the NHS. The cost associated with identifying the cause of stillbirth could offset the costs of care in the next pregnancy. Future research should concentrate on robust studies looking into the wider economic impact of stillbirth.

Dataset Information

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England.

Publications

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England.

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