Details of HTA project in progress
Last updated: 31 August 2010 - Next update due: 7 September 2010
Research type: |
Secondary Research (e.g. systematic review) |
Project title: |
Using evidence to reduce risk of healthcare acquired infection following primary hip replacement |
Project ref: |
08/13/02 |
Cost: |
£304,124 |
Chief Investigator : |
Mr Andre Charlett, Director, Department of Statistics Modelling and Economics, Health Protection Agency |
Start Date: |
November 2009 |
Estimated date of publication in HTA journal series: |
Early 2014. This date takes account of time for report preparation and printing based on current average times for these activities. |
Plain English Summary |
This research will identify the best way to prevent healthcare-acquired infections among patients who have a total hip replacement in the NHS. Modelling techniques will be used to examine the costs and benefits of increasing the scope and intensity of current infection-control arrangements. Because the NHS has scarce resources it is important to use resources efficiently. Changing infection control might be one way to improve efficiency. In 2006-07 almost 90,000 total hip replacements were performed in NHS hospital. Many of these patients get an infection that prolong stay in hospital and cause other costs. The patient will feel sick and they could die from the infection. Severe infections cause the hip replacement to fail and the surgery must be repeated. There are many different ways to prevent an infection ever happening. Current infection control practices vary widely among surgeons and hospitals. This is partly because the evidence is diverse and there is no consensus about which practices are optimal. This research will identify the evidence that is valid and reliable and discard the information that is biased and misleading. The evidence will be used to predict how costs and health benefits change for each infection control strategy. Some costs increase with more infection control but savings are also made if infections are prevented. The number of infections prevented will be estimated and the health benefits valued. There will be less illness and fewer premature deaths. Cost-effective infection-control strategies will be identified and communicated to policy makers who decide how NHS resources are used. If they are convinced that more infection control is good value for money, then scarce resources will be diverted from some other activity toward improving infection control. We will use existing data for this project and so the ethical risks are minor. The research team comprises health economists, statisticians, orthopaedic surgeons and infectious diseases doctors. Each member has specialist skills and a defined role. |
Project Abstract: |
Aim: to assess the cost-effectiveness of competing strategies that reduce risk of infection following hip replacement in an NHS hospital? Design: Decision analytic cost-effectiveness model informed by existing evidence. Target population: Patients undergoing primary hip replacement in NHS hospitals. Setting: NHS acute and community care services. Methods: State transition Markov models will be developed and updated with data that describe relevant parameters. Systematic reviews will be undertaken and the results meta-analysed. Other sources of evidence, such as surgical registers, will be assessed for quality and used to update model parameters. Uncertainties will be assessed by (i) probabilistic interpretation of parameter uncertainty (ii) important sources of variability will be considered. A Bayesian approach will allow external prior information (e.g. expert opinion) to be incorporated into the analysis. Markov Chain Monte Carlo (MCMC) re-sampling will be undertaken from each parameter distribution, in the WinBugs environment. The result will be a joint distribution of cost and QALY outcomes. These points describe the joint uncertainty among model parameters. Net monetary benefits will be calculated and described and interpreted for the purpose of decision making. Expected output of research: A comprehensive policy for the management of infection risk among patients undergoing primary hip replacement in NHS hospitals. The policy will depend on the cost-effectiveness criterion. There will be intermediate outcomes as we progress toward this goal: estimates of the clinical effects of risk reducing interventions; estimates of the changes to economic cost outcomes; and, estimates of the changes to health benefits. We will identify the efficient level of investment in infection control programmes, and identify the best strategies to implement. If the decision is highly uncertain, we will estimate the value of perfect information to inform future research efforts |
Project Protocol: |
Project protocol not available |
URL of this page: |
http://www.hta.ac.uk/2008 |
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