Model-based estimates of risks of disease transmission and economic costs of seven injection devices in sub-Saharan Africa *. (Research)

Objective To investigate and compare seven types of injection devices for their risks of iatrogenic transmission of bloodborne pathogens and their economic costs in sub-Saharan Africa. Methods Risk assumptions for each device and cost models were constructed to estimate the number of new hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections resulting from patient-to-patient, patient-to-health care worker, and patient-to-community transmission. Costs of device purchase and usage were derived from the literature, while costs of direct medical care and lost productivity from HBV and HIV disease were based on data collected in 1999 in Cote d'Ivoire, Ghana, and Uganda. Multivariate sensitivity analyses using Monte Carlo simulation characterized uncertainties in model parameters. Costs were summed from both the societal and health care system payer's perspectives. Findings Resterilizable and disposable needles and syringes had the highest overall costs for device purchase, usage, and iatrogenic disease: median US$ 26.77 and US$ 25.29, respectively, per injection from the societal perspective. Disposable-cartridge jet injectors and automatic needle-shielding syringes had the lowest costs, US$ 0.36 and US$ 0.80, respectively. Reusable-nozzle jet injectors and auto-disable needle and syringes were intermediate, at USS 0.80 and USS 0.91, respectively, per injection. Conclusion Despite their nominal purchase and usage costs, conventional needles and syringes carry a hidden but huge burden of iatrogenic disease. Alternative injection devices for the millions of injections administered annually in sub-Saharan Africa would be of value and should be considered by policy-makers in procurement decisions. Keywords Disease transmission; Iatrogenic disease/epidemiology; Injections/instrumentation/economics; Needles/adverse effects/ economics; Syringes/adverse effects/economics; Injections, Jet; Hepatitis B/transmission; HIV infections/transmission; Risk factors; Costs and cost analysis; Models, Theoretical; Africa South of the Sahara (source: MeSH, NLM). Mots cles Transmission maladie; Affection iatrogenique/epidemiologie; Injections/instrumentation/economie; Aiguille/effets indesirables/economie; Injections flash; Seringue/effets indesirables/economie; Hepatite B/transmission; HIV, Infection/transmission; Facteur risque; Cout et analyse cout; Modele theorique; Afrique subsaharienne (source: MeSH, INSERM). Palabras clave Transmision de enfermedad; Enfermedad iatrogenica/epidemiologia; Inyecciones/instrumentacion/economia; Agujas/efectos adversos/economia; Jeringas/efectos adversos/economia; Inyecciones a chorro; Hepatitis B/transmision; Infecciones por VIH/transmision; Factores de riesgo; Costos y analisis de costo; Modelos teoricos; Africa al Sur del Sahara (fuente: DeCS, BIREME). Bulletin of the World Health Organization 2002;80:859-870. Voir page 867 le resume en francais. En la pagina 867 figura un resumen en espanol.
Introduction The Expanded Programme on Immunization has been increasingly successful in reducing the incidence of vaccine-preventable diseases in developing countries (1), where, unfortunately, a pattern of unsafe injection practices has [...]