The cost-effectiveness of surgical instrument management policies to reduce the risk of vCJD transmission to humans
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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.
Keywordssimulation cost benefit analysis hospitals variant Creutzfeldt–Jakob disease (vCJD) replacement Bayesian inference
- Andrews NJ (2007). Incidence of variant Creutzfeldt–Jakob disease diagnoses and deaths in the UK January 1994–December 2007. Available from http://www.cjd.ed.ac.uk/cjdq56.pdf.
- Department of Health (2006a). Assessing the risk of vCJD transmission via surgery. An interim review. Econ Stat Opl Res (cited 10/11/06). Available from http://www.dh.gov.uk/assetRoot/04/11/35/42/04113542.pdf.
- Department of Health (2006b). Chief Executive Bulletin Issue 37 (cited 10/11/06). Available from http://www.publications.doh.gov.uk/cebulletin19oct.htm#1.
- Hospital Episode Statistics (2006) (cited 01/09/06). Available from http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=192.
- Ironside JW, Bishop MT, Connolly K, Hegazy D, Lowrie S, Le Grice M, Ritchie DL, McCardle LM and Hilton DA (2006). Variant Creutzfeldt–Jakob disease: Prion protein genotype analysis of positive appendix tissue samples from a retrospective prevalence study. BMJ 332(7551): 1186–1188.CrossRefGoogle Scholar
- Jacquez JA (1996). Compartmental Analysis in Biology and Medicine, 3rd edn.. BioMedWare: Ann Arbor, Michigan, USA.Google Scholar
- National Institute of Clinical Excellence (2004). Guide to the Methods of Technology Appraisal. Draft for consultation November 2007. Cited 20/02/08. National Institute of Clinical Excellence. Available from http://www.nice.org.uk/media/8AE/5C/TAMethodsguideUpdateFinalforConsultation281107.pdf.
- National Institute for Health and Clinical Excellence (2006). Patient safety and the risk of transmission of Creutzfeldt–Jakob disease (CJD) via interventional procedures (cited 25/11/06). Available from http://www.nice.org.uk/guidance/IPG196/guidance/pdf/English.
- Office for National Statistics (2006). Interim Life Tables, United Kingdom 2003–2005 http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=14459.
- Pharmaceutical Journal (2004). Preclinical vCJD: Prevalence higher than expected. Pharm J 272(7301): 663.Google Scholar
- Stevenson M, Oakley J and Chick SE (2006). Patient safety and reduction of risk of transmission of Creutzfeldt–Jakob disease (CJD) via interventional procedures—final report (second consultation) (cited 01/09/06). Available from http://www.nice.org.uk/guidance/IPG196/.
- The National Creutzfeldt–Jakob Disease Surveillance Unit, Edinburgh (2007). CJD Statistics (cited 22/08/2007). http://www.cjd.ed.ac.uk/figures.htm.
- The Royal College of Surgeons for England (2006). National Prospective Tonsillectomy Audit (cited 10/11/06). Available http://www.entuk.org/members/audits/tonsil/Tonsillectomyauditreport_pdf.
- Weinstein MC, O'Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C and Luce BR (2003). Principles of good practice for decision analytic modeling in health-care evaluation: Report of the ISPOR task force on good research practices—Modeling studies. Value in Health 6(1): 9–17.CrossRefGoogle Scholar