KEYWORDS:
Incremental cost-effectiveness ratio, Percutaneous injury

BACKGROUND:
Health care workers are at risk of exposure to bloodborne pathogens like hepatitis B, hepatitis C, and human immunodeficiency virus through percutaneous injuries (PI) caused by needlesticks. An estimated 600,000 to 800,000 PIs occur in the United States annually. Safety devices (SD) are effective in reducing PI. However, the higher cost of SDs is a major obstacle to their widespread use.

OBJECTIVE(S):
Assess the cost-effectiveness of SDs compared to conventional devices (CD).

METHOD(S):
A decision-analytic framework was used to assess the cost-effectiveness of SDs versus CDs. Incremental cost-effectiveness ratios were calculated for various scenarios of relative device cost and their effectiveness in reducing injuries. Input values included: CD cost=$0.08; PI risk from CD=4 per 100,000 needle use; PI cost from $2,000 to $5,000; relative reduction in PI using SD from 25% to 75%; and a SD cost from 2 to 4 times that of CD.

RESULT(S):
The costs per case of PI prevented ranged from -$2,333 (negative indicates savings) to $22,000. For the cost per case of PI prevented to be negative i.e., cost saving, at PI cost of $3,000; injury rates from SD must decline by at least 69% if the SD costs twice as much; or the SD cost should not be more than 2.125 times the CD cost, at 75% injury reduction rate using SD.

CONCLUSIONS(S):
SDs could be both effective in reducing PI and cost saving if the cost of such devices could be lowered to less than twice the cost of CD and the injury rate could be lowered by more than 75% using SD, and the PI cost is not less than $3,000.

LEARNING OBJECTIVES:
Demonstrate the cost-effectiveness of SDs versus CDs at various levels of the relative cost and effectiveness of SDs.