The gazette

February 2014 Highlights
New to HEED this month
We have added 75 new ful reviews and 11 non–English language articles from France, Spain and Germany. Featured Reviews
The following reviews are some of the highlights from this month’s issue of HEED: Economic evaluation of poison centers: a systematic review
Galvao T F, Silva E N, Silva M T, Bronstein A C, Pereira M G; International Journal of Technology Assessment in Health Care 2012; 28(2):86–92

Study Question: To undertake a systematic review of the literature on economic evaluations of poison
centers (PCs). Economic evaluation studies that compared PCs with an alternative intervention from the perspectives of society, the payer and the healthcare system were eligible for inclusion. There were no constraints on language or type of publication. The outcomes of interest were economic evaluations results (cost–benefit ratios, incremental cost-effectiveness ratios, incremental cost–utility ratios, and incremental costs). Literature was searched up to November 2011. Data extracted included the country and year in which the cost data were col ected, type of economic evaluation, time horizon, perspective, population, intervention, alternative intervention, discount rate, sensitivity analysis, scenarios adopted, costs measured, effectiveness considered and economic results. For papers that any of these data were missing, attempt was made to contact the corresponding author to obtain the needed information.
Patient Group: Poisoned individuals contacting the poison center for help and advice.

Key Results: Of th
e 422 non-duplicated studies retrieved, 9 met the eligibility criteria. In all studies, the presence of PCs was compared with a scenario of their absence. Eight studies used cost–benefit analysis (CBA) and one used a cost-effectiveness analysis (CEA). The cost–benefit ratios ranged from 0.76 to 7.67, while the CEA showed that each successful outcome achieved by a PC avoids a minimum of US$12,000– US$56,000 in other healthcare spending. The authors conclude that the results of their review show that PCs are economically viable and go on to suggest that an investment in PCs is a rational public health policy approach that contrasts the current trend of reducing spending on PCs. HEED News & Reviews
Incidence and cost of serious fall-related injuries in nursing homes
Quigley P A, Campbell R R, Bulat T, Olney R L, Buerhaus P, Needleman J; Clinical Nursing Research 2012; 21(1):10–23
Study Question: To estimate the cost of fal -related injuries (FRIs), with a nursing home as the source of
admission, in Veterans Administration (VA) and non-VA facilities. The study involved a retrospective analysis
Patient Group: Nursing home patients admitted to VA and non-VA facilities with fall-related injuries.

Key Results: Over a 3-year period, there were 2400 admissions to VHA hospitals for FRI, with 55.4% hip
fractures and10.1% intracranial injuries, with an average cost of US$23,723 per admission. Over a 9-year period, there were 141,308 admissions from nursing homes to non-VA hospitals for FRIs, with 38.8% hip fractures, 35.7% other fractures and 11.1% intracranial injuries, with an average cost of US$31,507 per admission. Prevention program emphasis should shift away from a focus on preventing falls as a measure of quality care to decreasing FRIs. These findings support implementation of injury prevention programs for the elderly that reduces risk for injury as the primary outcome. Estimating the lifelong health impact and financial burdens of different types of lung
Yang S C, Lai W W, Su W C, Wu S Y, Chen H H, Wu Y L, Hung M C, Wang J D; BMC Cancer 2013; 13:579

Study Question: To estimate the lifelong health impacts and financial burdens of different types of lung
cancer in Taiwan. The study uses a combination of primary data collection and analysing data from pre- existing databases to estimate financial burden and quality-adjusted life expectancy (QALE). Specifically, the study abstracted data from the National Cancer Registry for survival analysis, combined this with the national life tables to extrapolate the survival function to lifetime, collected quality-of-life (QoL) and costs data from lung cancer patients in the study hospital, and integrated the survival function with the QoL and costs to estimate the life expectancy, QALE, loss-of-QALE, and lifetime health care expenditures per case of
Patient Group: Patients with lung cancer in Taiwan. The EQ-5D-5L was administered to 1314 patients to

Key Results: The losses of QALE for patients with small cell lung cancer, squamous cell carcinoma and
adenocarcinoma were 13.69, 12.22 and 15.03 QALYs, respectively. The corresponding lifetime healthcare expenditures were US$18,455  ±  1,137, 20,599  ±  1,787, and 36,771  ±  1,998, respectively. In conclusion, the authors point out that the lifelong health impact and financial burdens in Taiwan are heavier for adenocarcinoma than for squamous cell carcinoma and suggest that the cost-effectiveness of prevention programmes could be directly compared with that of treatment strategies to improve patient value. HEED News & Reviews
Are educational interventions to prevent catheter-related bloodstream infections in
intensive care unit cost-effective?
Cooper K, Frampton G, Harris P, Jones J, Cooper T, Graves N, Cleland J, Shepherd J, Clegg A, Cuthbertson B H; Journal of Hospital Infection 2014; 86(1):47–52

Study Question: There is increasing interest in evidence-based educational interventions in central venous
catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits. Therefore, the aim of this study was to estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs. In order to do this, a comprehensive epidemiological and economic review was performed to develop the parameters for a decision analytic model to assess the cost-effectiveness of introducing an educational intervention compared with clinical practice without the intervention. The model follows the clinical pathway of cohorts of patients from their admission to an intensive care unit (ICU), where some may acquire catheter-BSI. The analysis was conducted from the perspective of the UK National Health Service (NHS).
Patient Group: Hypothetical cohorts of 100 adult patients treated with an educational intervention, such as
intravascular catheters, or clinical practice without the intervention. Data for the model were taken from adult patients in ICUs in England and Wales. Data were also taken from a systematic review of the clinical effectiveness of the educational intervention, literature searches, and through discussion with clinical
Key Results: The base-case results show that for every 100 patients admitted to intensive care, the CVC care
bundle cohort has 0.8 fewer catheter-BSIs than the current clinical practice cohort, and 0.3 fewer deaths during intensive care, which leads to an increased survival of 3.6 years and 2.7 QALYs. The additional cost for each catheter-BSI was £3940. The CVC care bundle is more effective and less costly (£1557) than current practice, with an additional cost per life-year saved of £439 and a cost per QALY gained of £573. The cost savings are largely as a result of the savings from reduced length of stay in the ICU. The additional cost per catheter-BSI averted was £1976. With the exception of the catheter-BSI incidence rate and the additional ICU length of stay for patients with catheter-BSI, the CVC care bundle is cheaper for all parameter values, and the model results are most sensitive to changes in these two parameters. Changes to these two parameters produced cost-effectiveness estimates that remained within acceptable limits. Based on these findings, the authors conclude that introducing an additional educational intervention improved patient life expectancy and reduced overal costs. The model results suggest that the cost of introducing the interventions wil be outweighed by savings related to reduced ICU bed occupancy costs. HEED News & Reviews
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