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Background <p>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.</p> Method <p>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.</p> Results <p>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.</p> Conclusion <p>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.</p> ClinicalTrials.gov registration <p>NCT02983136 and ISRCTN 17,022,695, retrospectively registered after data collection were completed.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月3日

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  • Sneha Abdul Jabbar,
  • Maria Frödin,
  • Ewa Wikström,
  • Brigid M. Gillespie,
  • Hanna Gyllensten,
  • Annette Erichsen

摘要

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.