Effectiveness of measures to prevent needlestick injuries among ...

5 Cost effectiveness
Both costs and benefits might affect more than one entity (e.g. health care provider,
health insurance, social security system), so interpretation of the results of cost-benefit
analyses depends on the unit of analysis used in the calculations (hospital or societal
level, and specific national health system).
5.1 Estimated costs of NSI
There is a broad range of costs of NSI reported in the literature (see examples in Table
13, see page 99). A recent report of the US General Accounting Office describes a
range of estimated average costs per NSI between $ 500 and $ 3,000 [22]. Several
factors contribute to these differences, making valid comparisons difficult.
First, analysts include different factors in their analyses, and hospitals calculate costs
differently. This is especially true for indirect costs. For example Jagger et al. [101]
estimated costs of NSI for two US hospitals for the time period 1995 to 1997, based
on the data recorded in the EPINet. Both hospitals were large. One was located in a
high-HIV prevalence area, the other one in a low-HIV prevalence area. Even though
the recorded average costs of NSI in both hospitals were similar (US $ 672 vs. US $
539), Jagger et al. found remarkable differences in the way the hospitals calculated
overall costs. For example, one hospital included the cost of lost work time, the other
did not; the costs for testing were very different between hospitals. The costs associated
with seroconversion were not considered.
Second, both direct and indirect cost estimates depend on characteristics that differ
between hospitals, including HBV vaccination status of the HCW, the status of the
patient population with respect to BBP, and the specific institutional protocols for
evaluation, treatment and follow-up after NSI [97; 98]. A low risk, low cost situation
arises when the source patient was known to be negative for BBP. A high risk, high
cost situation, e.g. if the source patient was HIV positive, may increase costs by a
factor between 3 to 10 [19; 33; 81; 97; 101; 103].
Finally, any cost estimates are strongly time-dependent in a double sense: Early
estimates [78] did not include any testing or PEP for HCV or HIV [98]; the latter has
accounted for the larges increase in NSI costs over the last decade [19]. Cost estimates
are also time-dependent in that the value of money changes over time. Even if
Report „Needlestick injuries“ 60