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Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India

Author

Listed:
  • Pankaj Bahuguna

    (Post Graduate Institute of Medical Education and Research)

  • Shankar Prinja

    (Post Graduate Institute of Medical Education and Research)

  • Chandrakant Lahariya

    (World Health Organization Country Office for India)

  • Radha Krishan Dhiman

    (Post Graduate Institute of Medical Education and Research)

  • Madhumita Prem Kumar

    (Post Graduate Institute of Medical Education and Research)

  • Vineeta Sharma

    (Post Graduate Institute of Medical Education and Research)

  • Arun Kumar Aggarwal

    (Post Graduate Institute of Medical Education and Research)

  • Rajesh Bhaskar

    (Department of Health and Family Welfare)

  • Hilde Graeve

    (World Health Organization Country Office for India)

  • Henk Bekedam

    (World Health Organization Country Office for India)

Abstract

Background Globally, 16 billion injections are administered each year of which 95% are for curative care. India contributes 25–30% of the global injection load. Over 63% of these injections are reportedly unsafe or deemed unnecessary. Objectives To assess the incremental cost per quality-adjusted life-year (QALY) gained with the introduction of safety-engineered syringes (SES) as compared to disposable syringes for therapeutic care in India. Methods A decision tree was used to compute the volume of needle-stick injuries (NSIs) and reuse episodes among healthcare professionals and the patient population. Subsequently, three separate Markov models were used to compute lifetime costs and QALYs for individuals infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Three SES were evaluated—reuse prevention syringe (RUP), sharp injury prevention (SIP) syringe, and syringes with features of both RUP and SIP. A lifetime study horizon starting from a base year of 2017 was considered appropriate to cover all costs and consequences comprehensively. A systematic review was undertaken to assess the SES effects in terms of reduction in NSIs and reuse episodes. These were then modelled in terms of reduction in transmission of blood-borne infections, life-years and QALYs gained. Future costs and consequences were discounted at the rate of 3%. Incremental cost per QALY gained was computed to assess the cost-effectiveness. A probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. Results The introduction of RUP, SIP and RUP + SIP syringes in India is estimated to incur an incremental cost of Indian National Rupee (INR) 61,028 (US$939), INR 7,768,215 (US$119,511) and INR 196,135 (US$3017) per QALY gained, respectively. A total of 96,296 HBV, 44,082 HCV and 5632 HIV deaths are estimated to be averted due to RUP in 20 years. RUP has an 84% probability to be cost-effective at a threshold of per capita gross domestic product (GDP). The RUP syringe can become cost saving at a unit price of INR 1.9. Similarly, SIP and RUP + SIP syringes can be cost-effective at a unit price of less than INR 1.2 and INR 5.9, respectively. Conclusion RUP syringes are estimated to be cost-effective in the Indian context. SIP and RUP + SIP syringes are not cost-effective at the current unit prices. Efforts should be made to bring down the price of SES to improve its cost-effectiveness.

Suggested Citation

  • Pankaj Bahuguna & Shankar Prinja & Chandrakant Lahariya & Radha Krishan Dhiman & Madhumita Prem Kumar & Vineeta Sharma & Arun Kumar Aggarwal & Rajesh Bhaskar & Hilde Graeve & Henk Bekedam, 2020. "Cost-Effectiveness of Therapeutic Use of Safety-Engineered Syringes in Healthcare Facilities in India," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 393-411, June.
    • Handle: RePEc:spr:aphecp:v:18:y:2020:i:3:d:10.1007_s40258-019-00536-w
    DOI: 10.1007/s40258-019-00536-w
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    References listed on IDEAS

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    1. Shankar Prinja & Akashdeep Chauhan & Blake Angell & Indrani Gupta & Stephen Jan, 2015. "A Systematic Review of the State of Economic Evaluation for Health Care in India," Applied Health Economics and Health Policy, Springer, vol. 13(6), pages 595-613, December.
    2. Shankar Prinja & Pankaj Bahuguna & Ajay Duseja & Manmeet Kaur & Yogesh Kumar Chawla, 2018. "Cost of Intensive Care Treatment for Liver Disorders at Tertiary Care Level in India," PharmacoEconomics - Open, Springer, vol. 2(2), pages 179-190, June.
    3. Briggs, Andrew & Sculpher, Mark & Claxton, Karl, 2006. "Decision Modelling for Health Economic Evaluation," OUP Catalogue, Oxford University Press, number 9780198526629.
    4. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
    5. Shankar Prinja & Laura E. Downey & Vijay K. Gauba & Soumya Swaminathan, 2018. "Health Technology Assessment for Policy Making in India: Current Scenario and Way Forward," PharmacoEconomics - Open, Springer, vol. 2(1), pages 1-3, March.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 1st June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-01 11:00:00

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