Abstract:
BACKGROUND. Healthcare workers (HCWs) are at increased risk of contracting various communicable diseases. Needlestick injuries (NSIs)
are a common mechanism of exposure. Training in basic universal precautions and utilisation of safety-engineered devices (SEDs) are
interventions known to reduce the risk of NSI.
OBJECTIVES. To assess the cost-utility of SEDs v. a training programme in universal precautions (TP) v. a combination strategy to reduce
NSIs among South African HCWs.
METHODS. A Markov model comparing SEDs v. a TP v. a combination strategy against current practice was developed. A hypothetical cohort
of HCWs working in the SA public sector was followed from a payer’s perspective for a period of 45 years, and discounted costs and benefits
were assessed. Data were obtained from the National Department of Health, suppliers and published literature. One-way and probabilistic
sensitivity analysis was conducted.
RESULTS. Over the study time horizon, our model estimated that 2 209, 3 314 and 4 349 needlestick injuries per 1 000 HCWs could
be prevented if a TP, SEDs or a combination strategy, respectively, was adopted compared with current practice. All three candidate
interventions were cost-effective at a willingness to pay (WTP) of one times the gross domestic product per capita (USD6 483.90/qualityadjusted
life-year (QUALY) gained). SEDs as a stand-alone intervention was dominated by a combination strategy. Compared with current
practice, the incremental cost-effectiveness of training was USD32.90/QALY v. USD432.32/QALY for SEDs and USD377.08/QALY for a
combination strategy. Results were sensitive to the effectiveness of the interventions. Probabilistic sensitivity analysis showed that at a WTP
of USD6 483.90/QALY gained, a combination strategy would be cost-effective 95.4% of the time.
CONCLUSIONS. A combination strategy in which both SEDs and a TP are adopted is preferred.
