Andy Healey1,2, Eirik Søfteland3,4, Stig Harthug5,6, Rune Haaverstad5,7, Rupavathana Mahesparan8, Bjørg Merete Hjallen9, Geir Egil Eide10,11, Nick Sevdalis1, Arvid Steinar Haugen3. 1. Center for Implementation Science, Health Service, and Population Research Department, King's College London, London, United Kingdom. 2. King's Health Economics, Health Service, and Population Research Department, King's College London, London United Kingdom. 3. Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. 4. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 5. Department of Clinical Science, University of Bergen, Bergen, Norway. 6. Department of Research and Development, Haukeland University Hospital, Bergen, Norway. 7. Department of Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway. 8. Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway. 9. Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway. 10. Center for Clinical Research, Haukeland University Hospital, Bergen, Norway. 11. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Abstract
OBJECTIVES: To evaluate cost-effectiveness of the WHO Surgical Safety Checklist. BACKGROUND: The clinical effectiveness of surgical checklists is largely understood. Few studies to-date have evaluated the cost-effectiveness of checklist use. METHODS: An economic evaluation was carried out using data from the only available randomized controlled trial of the checklist. Analyses were based on 3702 procedures. Costs considered included checklist implementation costs and length and cost of hospital stay, costs of warming blanket use, blood transfusions and antibiotics used in the operating room, and the cost of clinical time in the operating room - all calculated for each procedure and its associated admission. Nonparametric bootstrapping was used to simulate an empirical distribution of the mean effect of the checklist on total admission costs and the probability of observing a complication-free admission and to quantify sampling uncertainty around mean cost estimates. RESULTS: The overall cost of checklist implementation was calculated to be $900 per 100 admissions. Implementation of the WHO checklist resulted in an additional 5.9 complication-free admissions per 100 admissions and an average of 110 bed-days saved per 100 admissions. Accounting for all costs included in the analysis, for every 100 admissions, use of the WHO checklist was estimated to save $55,899. CONCLUSIONS: Implementation of the WHO checklist was a cost-effective strategy for improving surgical safety.
OBJECTIVES: To evaluate cost-effectiveness of the WHO Surgical Safety Checklist. BACKGROUND: The clinical effectiveness of surgical checklists is largely understood. Few studies to-date have evaluated the cost-effectiveness of checklist use. METHODS: An economic evaluation was carried out using data from the only available randomized controlled trial of the checklist. Analyses were based on 3702 procedures. Costs considered included checklist implementation costs and length and cost of hospital stay, costs of warming blanket use, blood transfusions and antibiotics used in the operating room, and the cost of clinical time in the operating room - all calculated for each procedure and its associated admission. Nonparametric bootstrapping was used to simulate an empirical distribution of the mean effect of the checklist on total admission costs and the probability of observing a complication-free admission and to quantify sampling uncertainty around mean cost estimates. RESULTS: The overall cost of checklist implementation was calculated to be $900 per 100 admissions. Implementation of the WHO checklist resulted in an additional 5.9 complication-free admissions per 100 admissions and an average of 110 bed-days saved per 100 admissions. Accounting for all costs included in the analysis, for every 100 admissions, use of the WHO checklist was estimated to save $55,899. CONCLUSIONS: Implementation of the WHO checklist was a cost-effective strategy for improving surgical safety.