Case-Oriented Paper

Journal of the Operational Research Society

, Volume 60, Issue 4, pp 506-518

First online:

The cost-effectiveness of surgical instrument management policies to reduce the risk of vCJD transmission to humans

  • M D StevensonAffiliated withSchool of Health and Related Research, University of Sheffield Email author 
  • , J E OakleyAffiliated withDepartment of Probability and Statistics, University of Sheffield
  • , S E ChickAffiliated withTechnology and Operations Management Area, INSEAD
  • , K ChalkidouAffiliated withNational Institute for Health and Clinical Excellence

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Current sterilization techniques may not be completely effective at removing prions from surgical instruments, which can then infect patients on whom these instruments are subsequently used. This risk is increased due to the current level of instrument migration. With wide uncertainty in the numbers of patients that are incubating variant Creutzfeldt–Jakob disease (vCJD) and effectiveness of decontamination, the UK is facing a potentially self-sustaining epidemic, which could be averted with the introduction of single-use instruments. This paper focuses on the cost-effectiveness of management strategies concerning the introduction of single-use instruments and measures to prevent migration. We formulated a discrete event simulation model of the dynamics of infection transmission, surgical instrument contamination and migration, to produce results that were pivotal in shaping government policy. Field data about vCJD transmission has then been used to update cost-effectiveness assessments as part of a retrospective analysis, which reinforces the initial decision.


simulation cost benefit analysis hospitals variant Creutzfeldt–Jakob disease (vCJD) replacement Bayesian inference