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 costeffectiveness 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 nonrandomized controlled trail comparing "Bundle precautions" to nonBundle 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.