Clinical scenario

A rural hospital hires a new infection control professional, EL, who has just received her master’s degree and trained in infection control departments that were up to date on the best evidence. EL reviews the infection control policies and learns that traditional central line catheters are used. Where she trained, a new, more expensive, antiseptic catheter was used. The new catheter is impregnated with chlorhexidine and silver sulfadiazine and costs $25 more than the traditional catheter.

Because the new catheter is designed to reduce the incidence of hospital associated infections, particularly blood stream infections that are catheter related, EL recommends that the hospital begin using it in place of the traditional central line catheter. However, hospital administration and the purchasing department question the value of this new, more expensive, antiseptic impregnated catheter. Issues related to both cost and the possibility of improved outcomes are discussed at a meeting with intensive care nurses, physicians, and representatives from hospital administration and the purchasing department. Specifically, the questions are: (1) is the antiseptic impregnated catheter economically efficient? In other words, are the additional costs of the catheter offset by potential cost savings in reduced number of infections, which will affect length of stay? (2) Is the antiseptic impregnated catheter more cost effective when used in certain types of patients (eg, patients at high risk of catheter related infections, such as immunosuppressed patients)? An interdisciplinary team is asked to conduct a literature search and make an evidence-based recommendation.

Introduction

As healthcare technology continues to expand, the cost of using all effective clinical services exceeds available resources. Because of the scarcity of resources, decisions regarding the implementation of new services frequently need to be based on economic analysis. Economic analysis is a set of formal, quantitative methods used to compare 2 or more treatments, programmes, or …