title: Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.
abstract: BACKGROUND
  The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included.
  
  
  METHODS
  The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012.
  
  
  RESULTS
  No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits.
  
  
  CONCLUSIONS
  The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Nicholas
authors: N
authors: Graves
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Katie
authors: K
authors: Page
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Elizabeth
authors: E
authors: Martin
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: David
authors: D
authors: Brain
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Lisa
authors: L
authors: Hall
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Megan
authors: M
authors: Campbell
authors: Department of Applied Health Research, University College London, London, United Kingdom.
authors: Naomi
authors: N
authors: Fulop
authors: School of Management, Queensland University of Technology, Brisbane, Australia.
authors: Nerina
authors: N
authors: Jimmeison
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Katherine
authors: K
authors: White
authors: Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.
authors: David
authors: D
authors: Paterson
authors: Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
authors: Adrian G
authors: AG
authors: Barnett
mesh_terms: D016470:Bacteremia / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D019983:Guideline Adherence / Q000191:economics* / Q000706:statistics & numerical data; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000191:economics*; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D012306:Risk; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000502:physiology*