An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden.

Abstract

Background: A theory-driven knowledge translation program was established to co-create and implement evidence-based practices to prevent urinary catheter-associated urinary tract infections (UC-UTIs) and bladder distension (BD). This study investigates the cost-effectiveness of implementing the Safe Hands and Safe Bladder bundle intervention compared to standard care for patients undergoing hip fracture surgery in Sweden.

Method: The study included outcomes from a quality register of patients who underwent hip fracture surgery at a Swedish hospital from 2015 to 2020. Adopting a healthcare perspective, estimates for the implementation cost were derived using activity-based costing, while the bundle's cost-effectiveness was estimated using a decision tree model. Health outcomes were evaluated based on adverse events, specifically UC-UTI and BD. Analyses included calculating the incremental cost-effectiveness ratio (ICER), which denotes the incremental cost per added infection rate expressed as a percentage. Additionally, sensitivity analyses were conducted to test the robustness of the results under alternative cost assumptions.

Results: The likelihood of avoiding BD or UC-UTI increased from 50 to 87% over the course of the intervention year. The discounted implementation cost was SEK 890,389 (corresponding to Int$ 102,721). However, the implementation cost was offset by costs for a prolonged hospital stay due to these adverse events, resulting in an overall cost savings of SEK - 7,334 per patient (Int$ -846) in 2020 compared to before the intervention was introduced. Consequently, the intervention proved to be cost-effective, leading to savings and a decrease in the occurrence of adverse events.

Conclusion: Implementing the bundle intervention in units providing care for patients with acute hip fractures proved cost-effective. This offers decision makers valuable insights and demonstrates that implementation programs incorporating collaboration, facilitation and co-creation processes can effectively use limited resources. Further research should determine the generalizability of the findings to other settings and populations.

Clinicaltrials:

Gov registration: NCT02983136 and ISRCTN 17,022,695, retrospectively registered after data collection were completed.