Blue Ribbon Abstract Award, Best International Abstract Award: Cost-Effectiveness of Safety Devices in Preventing Hepatitis C Infection due to Percutaneous Injuries in Japanese Healthcare Workers—A Markov Model Analysis

BACKGROUND: High incidence of hepatitis C virus (HCV) infection among Japanese healthcare workers (HCWs) following a percutaneous injury (PI) has been reported in multiple studies. A lack of regulations mandating the use of safety devices and their high costs prevent many Japanese hospitals from purchasing these devices to prevent PIs. A few studies have evaluated the cost-effectiveness of safety devices from hospital administratorsʹ perspectives using data from a single hospital; however, the results have been equivocal. The cost-effectiveness of safety devices has never been analyzed from the perspective of the Japanese government, which that compensates medical costs incurred by PIs from known infective sources. METHODS: We constructed a Markov model to assess the cost-effectiveness of two types of safety devices—winged steel needles and intravenous catheters—in preventing HCV infection due to PIs from the Japanese governmentʹs perspective. Clinical and utility data were obtained from published studies. Costs were based on both published and unpublished data in Japan. Cost-effectiveness was measured by yen per quality-adjusted life year (¥/QALY). RESULTS: The baseline analyses showed the use of both types of safety devices to be cost-effective. Costs of safety and conventional winged steel needles per QALY were ¥4680 and ¥5220, respectively. Safety winged steel needles were no longer dominant when they reduced PI incidence by less than 46% (maximum incremental cost ¥1650/QALY), the prevalence of HCV infection in patients was less than 7% (maximum incremental cost ¥740/QALY), and their cost exceeded ¥8230/QALY (maximum incremental cost ¥6380/QALY). For IV catheters, costs of safety and conventional devices per QALY were ¥18,850 and ¥20,010 respectively. The use of safety IV catheter lost its dominance when the safety device reduced PI incidence by 80% or less (maximum incremental cost ¥9670/QALY), the prevalence of hepatitis C infection in patients was 7% or less (maximum incremental cost ¥4310/QALY), and their cost exceeded ¥38,670/QALY (maximum incremental cost ¥26,220/QALY). CONCLUSIONS: From the Japanese governmentʹs perspective, use of safety winged steel needles and IV catheters is cost-effective in preventing HCV infection due to PIs. Creating legal and financial incentives for hospitals to use safety devices and reinforcing needlestick prevention activities will result in lower costs of safety devices as well as higher reduction rates in PIs, which will further enhance the cost-effectiveness of these devices.