Cost Effectiveness Analysis of Bundle versus No Bundle Strategy during Central Venous Catheter Insertion on Reduction of Central Line-Associated Bloodstream Infections in Abu El Reesh Hospital, Egypt.

Background: Central line-associated bloodstream infections (CLABSI) are frequent, costly to payers and patients, and potentially fatal. This paper aims to appraise the cost-effectiveness of implementing "Bundle precautions" during Central Venous Catheter (CVC) insertion, focusing on reducing CLABSI infections from the hospital perspective.
Objective: To determine cost-effectiveness of using bundle versus non-bundle application in term of nosocomial infection rate. Method: Economic evaluation sub-study, parallel to a non- randomized controlled trail comparing "Bundle precautions" to non- Bundle precautions applied to patients with CVC insertion. The study was conducted in intensive care units, teaching pediatric hospital. Pediatric patients in 2 months to age of 18 years age interval, requiring CVC insertion were recruited following ICU admission and classified into 2 groups with one group receiving bundle precautions and one not. Economic costs of "Bundle precautions" versus "No Bundle precautions" of central line-associated bloodstream infections were estimated from the perspective of the hospital in 2015 Egyptian pounds. Primary main outcome measure is Central line-associated bloodstream infections prevented. Cost-effectiveness ratios were estimated. One way sensitivity analysis was performed. Results: Weighed against the current practice, the "Bundle precautions" is strongly dominant; approx. 482.95 LE were saved, and about 9.8 episodes of CLABSI/1000 CVL were avoided. In One-way sensitivity analysis, Bundle precautions continued to be a dominant strategy. Conclusions: Use of "Bundle precautions" during CVC insertion lowers medical costs and decreases the incidence of Central line-associated bloodstream infections. Cost savings were found over a range of clinical and economic assumptions, suggesting that "Bundle precautions" should be routinely used during CVCs insertion at Abu-El Reesh Hospital' Pediatric Intensive Care Unit.