title: Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA.
abstract: OBJECTIVE
  To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units.
  
  
  METHODS
  Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units.
  
  
  METHODS
  USA.
  
  
  METHODS
  Adult patients in the intensive care unit.
  
  
  RESULTS
  Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars.
  
  
  METHODS
  Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed.
  
  
  RESULTS
  Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections' economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses.
  
  
  CONCLUSIONS
  This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections.
authors.affiliation: Medical Scientist Training Program, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Kurt R
authors.initials: KR
authors.lastname: Herzer
authors.affiliation: Centre for Applied Health Research and Delivery (CAHRD), Liverpool School of Tropical Medicine, University of Warwick, Coventry, UK.
authors.forename: Louis
authors.initials: L
authors.lastname: Niessen
authors.affiliation: International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Dagna O
authors.initials: DO
authors.lastname: Constenla
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ward
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
mesh_terms: D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000592:standards; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics*; D014481:United States / Q000453:epidemiology