Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review. Issue 4 (25th November 2021)

• Record Type: Journal Article
• Authors: McCleskey, Sara G; Shek, Lili; Grein, Jonathan; Gotanda, Hiroshi; Anderson, Laura; Shekelle, Paul G; Keeler, Emmett; Morton, Sally; Nuckols, Teryl K
• Is Part Of: BMJ quality & safety. Volume 31:Issue 4(2022)
• Page Start: 308
• Page End: 321
• Publication Date: 2021-11-25
• Subjects: quality improvement -- nosocomial infections -- cost-effectiveness; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2021-013839
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: Hospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain. Objective: To systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals. Methods: A search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine's Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020. We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs. Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study. Results: Fifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care. Conclusions: QI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.