Economic evaluation of safety-engineered devices and training in reducing needlestick injuries among healthcare workers in South Africa

P de Jager, M Zungu, R E Dyers


Background. Healthcare workers (HCWs) are at increased risk of contracting various communicable diseases. Needlestick injuries (NSIs) are a common mechanism of exposure. Training in basic universal precautions and utilisation of safety-engineered devices (SEDs) are interventions known to reduce the risk of NSI.

Objectives. To assess the cost-utility of SEDs v. a training programme in universal precautions (TP) v. a combination strategy to reduce NSIs among South African HCWs.

Methods. A Markov model comparing SEDs v. a TP v. a combination strategy against current practice was developed. A hypothetical cohort of HCWs working in the SA public sector was followed from a payer’s perspective for a period of 45 years, and discounted costs and benefits were assessed. Data were obtained from the National Department of Health, suppliers and published literature. One-way and probabilistic sensitivity analysis was conducted.

Results. Over the study time horizon, our model estimated that 2 209, 3 314 and 4 349 needlestick injuries per 1 000 HCWs could be prevented if a TP, SEDs or a combination strategy, respectively, was adopted compared with current practice. All three candidate interventions were cost-effective at a willingness to pay (WTP) of one times the gross domestic product per capita (USD6 483.90/quality-adjusted life-year (QUALY) gained). SEDs as a stand-alone intervention was dominated by a combination strategy. Compared with current practice, the incremental cost-effectiveness of training was USD32.90/QALY v. USD432.32/QALY for SEDs and USD377.08/QALY for a combination strategy. Results were sensitive to the effectiveness of the interventions. Probabilistic sensitivity analysis showed that at a WTP of USD6 483.90/QALY gained, a combination strategy would be cost-effective 95.4% of the time.

Conclusions. A combination strategy in which both SEDs and a TP are adopted is preferred.


Authors' affiliations

P de Jager, Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Social Policy, London School of Economics and Political Science, London, UK

M Zungu, HIV/TB Unit, National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa; School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa

R E Dyers, Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Western Cape Government: Health, South Africa

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Healthcare workers; Needlestick injuries; Cost-effectiveness analysis; South Africa; HIV; Prevention; Safety-engineered devices; Training, Health technology assessment

Cite this article

South African Medical Journal 2018;108(6):477-483. DOI:10.7196/SAMJ.2018.v108i6.12913

Article History

Date submitted: 2018-05-25
Date published: 2018-05-25

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