Implementing a thermal care bundle for inadvertent perioperative hypothermia: a cost-effectiveness analysis

Conway, Aaron and Gow, Jeffrey and Ralph, Nicholas and Duff, Jed and Edward, Karen-Leigh and Alexander, Kimberly and Munday, Judy and Brauer, Anselm (2019) Implementing a thermal care bundle for inadvertent perioperative hypothermia: a cost-effectiveness analysis. International Journal of Nursing Studies, 97. pp. 21-27. ISSN 0020-7489

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Abstract

Background
Active warming reduces risk of surgical complications. Implementation of a perioperative thermal care bundle increased use of active warming for surgical patients.

Objective
This study aimed to determine if implementing a thermal care bundle to prevent inadvertent perioperative hypothermia is cost-effective.

Design
A model-based cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects.

Setting
Hospitals undertaking between 5,000 and 40,000 surgeries per year, which either implemented or did not implement the thermal care bundle, were modelled.

Participants
The decision tree guiding the structure of the model was populated with clinical outcomes (surgical site infection, blood transfusion requirement and morbid cardiac events) of a hypothetical cohort of surgical patients.

Interventions
Implementation or non-implementation of the thermal care bundle.

Main outcome measures
Net monetary benefit was calculated by multiplying the health benefits (quality-adjusted life years) by the willingness-to-pay threshold minus the cost. We tested a range of values for willingness to pay per quality-adjusted life year thresholds and plotted results for expected incremental benefits and probability of cost-effectiveness. The incremental cost-effectiveness ratio was also calculated.

Results
Thermal care bundle implementation simultaneously reduced costs and increased quality-adjusted life years in the majority of simulations (88.1%). The average cost reduction was $689,659 (95% credible intervals spanned from a $2,718,364 decrease in costs to $379,826 increase in costs) and average difference in quality-adjusted life years was 54 (95% CI = 0.4 less to 176 more). This equated to an incremental cost-effectiveness ratio of $12747 saved per quality-adjusted life year gained.

Conclusions
It is likely that increasing use of active warming by implementing the thermal care bundle would generate cost-savings and improve the quality of life for surgical patients. It would be good value for hospitals with similar characteristics to those included in our model to allocate the extra resources required for implementation.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Additional Information: Accepted version embargoed until 1 October 2020 (12 months), in accordance with the copyright policy of the publisher.
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Faculty/School / Institute/Centre: Current - Faculty of Health, Engineering and Sciences - School of Nursing and Midwifery (1 Jan 2015 -)
Date Deposited: 15 Oct 2019 03:13
Last Modified: 15 Oct 2019 03:13
Uncontrolled Keywords: active warming; hypothermia prevention; nurses; nursing; temperature; costs
Fields of Research : 11 Medical and Health Sciences > 1110 Nursing > 111003 Clinical Nursing: Secondary (Acute Care)
Socio-Economic Objective: C Society > 92 Health > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920118 Surgical Methods and Procedures
Identification Number or DOI: 10.1016/j.ijnurstu.2019.04.017
URI: http://eprints.usq.edu.au/id/eprint/36357

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