De Jager, P.Zungu, MuzimkhuluDyers, R.E.2019-07-312019-07-312018-06De Jager, P., Zungu, M. & Dyers, R.E. 2018, 'Economic evaluation of safety-engineered devices and training in reducing needlestick injuries among healthcare workers in South Africa', South African Medical Journal, vol. 108, no. 6, pp. 477-483.0256-9574 (print)2078-5135 (online)10.7196/SAMJ.2018.v108i6.12913http://hdl.handle.net/2263/70837BACKGROUND. 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.Afrikaans© 2019, South African Medical Association. All rights reserved. This article is licensed under a Creative Commons Attribution-NonCommercial Works License (CC BY-NC 3.0).Healthcare workers (HCWs)Willingness to pay (WTP)Needlestick injuriesTraining programmeArticle