An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden
Abstract Background A theory-driven knowledge translation program was established to co-create and implement evidence-based practices to prevent urinary catheter-associated urinary tract infections (UC-UTIs) and bladder distension (BD). This study investigates the cost-effectiveness of implementing...
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BMC
2025-07-01
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| Series: | Antimicrobial Resistance and Infection Control |
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| Online Access: | https://doi.org/10.1186/s13756-025-01573-y |
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| author | Sneha Abdul Jabbar Maria Frödin Ewa Wikström Brigid M. Gillespie Hanna Gyllensten Annette Erichsen |
| author_facet | Sneha Abdul Jabbar Maria Frödin Ewa Wikström Brigid M. Gillespie Hanna Gyllensten Annette Erichsen |
| author_sort | Sneha Abdul Jabbar |
| collection | DOAJ |
| description | Abstract Background A theory-driven knowledge translation program was established to co-create and implement evidence-based practices to prevent urinary catheter-associated urinary tract infections (UC-UTIs) and bladder distension (BD). This study investigates the cost-effectiveness of implementing the Safe Hands and Safe Bladder bundle intervention compared to standard care for patients undergoing hip fracture surgery in Sweden. Method The study included outcomes from a quality register of patients who underwent hip fracture surgery at a Swedish hospital from 2015 to 2020. Adopting a healthcare perspective, estimates for the implementation cost were derived using activity-based costing, while the bundle’s cost-effectiveness was estimated using a decision tree model. Health outcomes were evaluated based on adverse events, specifically UC-UTI and BD. Analyses included calculating the incremental cost-effectiveness ratio (ICER), which denotes the incremental cost per added infection rate expressed as a percentage. Additionally, sensitivity analyses were conducted to test the robustness of the results under alternative cost assumptions. Results The likelihood of avoiding BD or UC-UTI increased from 50 to 87% over the course of the intervention year. The discounted implementation cost was SEK 890,389 (corresponding to Int$ 102,721). However, the implementation cost was offset by costs for a prolonged hospital stay due to these adverse events, resulting in an overall cost savings of SEK − 7,334 per patient (Int$ -846) in 2020 compared to before the intervention was introduced. Consequently, the intervention proved to be cost-effective, leading to savings and a decrease in the occurrence of adverse events. Conclusion Implementing the bundle intervention in units providing care for patients with acute hip fractures proved cost-effective. This offers decision makers valuable insights and demonstrates that implementation programs incorporating collaboration, facilitation and co-creation processes can effectively use limited resources. Further research should determine the generalizability of the findings to other settings and populations. ClinicalTrials.gov registration NCT02983136 and ISRCTN 17,022,695, retrospectively registered after data collection were completed. |
| format | Article |
| id | doaj-art-0b2a3b80a2f44e468bc5d2fcdedc6cd3 |
| institution | Kabale University |
| issn | 2047-2994 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj-art-0b2a3b80a2f44e468bc5d2fcdedc6cd32025-08-20T03:45:36ZengBMCAntimicrobial Resistance and Infection Control2047-29942025-07-0114111210.1186/s13756-025-01573-yAn economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in SwedenSneha Abdul Jabbar0Maria Frödin1Ewa Wikström2Brigid M. Gillespie3Hanna Gyllensten4Annette Erichsen5Sahlgrenska Academy, University of GothenburgInstitute of Health and Care Sciences, University of GothenburgSchool of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Västra GötalandregionenNational Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareInstitute of Health and Care Sciences, University of GothenburgInstitute of Health and Care Sciences, University of GothenburgAbstract Background A theory-driven knowledge translation program was established to co-create and implement evidence-based practices to prevent urinary catheter-associated urinary tract infections (UC-UTIs) and bladder distension (BD). This study investigates the cost-effectiveness of implementing the Safe Hands and Safe Bladder bundle intervention compared to standard care for patients undergoing hip fracture surgery in Sweden. Method The study included outcomes from a quality register of patients who underwent hip fracture surgery at a Swedish hospital from 2015 to 2020. Adopting a healthcare perspective, estimates for the implementation cost were derived using activity-based costing, while the bundle’s cost-effectiveness was estimated using a decision tree model. Health outcomes were evaluated based on adverse events, specifically UC-UTI and BD. Analyses included calculating the incremental cost-effectiveness ratio (ICER), which denotes the incremental cost per added infection rate expressed as a percentage. Additionally, sensitivity analyses were conducted to test the robustness of the results under alternative cost assumptions. Results The likelihood of avoiding BD or UC-UTI increased from 50 to 87% over the course of the intervention year. The discounted implementation cost was SEK 890,389 (corresponding to Int$ 102,721). However, the implementation cost was offset by costs for a prolonged hospital stay due to these adverse events, resulting in an overall cost savings of SEK − 7,334 per patient (Int$ -846) in 2020 compared to before the intervention was introduced. Consequently, the intervention proved to be cost-effective, leading to savings and a decrease in the occurrence of adverse events. Conclusion Implementing the bundle intervention in units providing care for patients with acute hip fractures proved cost-effective. This offers decision makers valuable insights and demonstrates that implementation programs incorporating collaboration, facilitation and co-creation processes can effectively use limited resources. Further research should determine the generalizability of the findings to other settings and populations. ClinicalTrials.gov registration NCT02983136 and ISRCTN 17,022,695, retrospectively registered after data collection were completed.https://doi.org/10.1186/s13756-025-01573-yBundle interventionsHospital-acquired infectionsAdverse eventsBladder distensionCatheter-associated urinary tract infectionsImplementation costs |
| spellingShingle | Sneha Abdul Jabbar Maria Frödin Ewa Wikström Brigid M. Gillespie Hanna Gyllensten Annette Erichsen An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden Antimicrobial Resistance and Infection Control Bundle interventions Hospital-acquired infections Adverse events Bladder distension Catheter-associated urinary tract infections Implementation costs |
| title | An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden |
| title_full | An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden |
| title_fullStr | An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden |
| title_full_unstemmed | An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden |
| title_short | An economic evaluation of a hospital-wide bundle intervention to reduce hospital-acquired infections and bladder distension among hip fracture patients in Sweden |
| title_sort | economic evaluation of a hospital wide bundle intervention to reduce hospital acquired infections and bladder distension among hip fracture patients in sweden |
| topic | Bundle interventions Hospital-acquired infections Adverse events Bladder distension Catheter-associated urinary tract infections Implementation costs |
| url | https://doi.org/10.1186/s13756-025-01573-y |
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