Feeding innovation – Update on the feed innovation toolkit and where we are with FEAST and Techfit

<p>All cost thresholds represent nationwide implementation costs over an 18mth period. Costs per ICU can be obtained by dividing each figure by 46 e.g. given RR  = 0.34 the cost threshold per ICU for the bundle relative to no intervention equals $4,349,730/46 =$94,559.</p><p>It is important to note that when both CH/SSD and MR catheters are being considered, the MR catheters are the preferred option where the bundle is dominated for all scenarios except where health benefits are valued at zero and bed-days only at the value of variable costs. Under this scenario where the bundle is dominated the MR catheters are not cost-effective as the cost per QALY exceeds $64,000 and it is the CH/SSD catheters that are preferred, hence the shift in the threshold seen in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0012815#pone-0012815-g003" target="_blank">Figure 3c</a>.</p

Resources potentially required to implement a catheter care bundle.

<p>*Keystone funded to $15 million to undertake multiple projects not just a catheter care bundle.</p><p>Resources were identified based on the following publications:</p><p>Pronovost PJ, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C: Improving communication in the ICU using daily goals. J Crit Care 2003, 18:71–75.</p><p>Pronovost PJ, Weast B, Bishop K, Paine L, Griffith R, Rosenstein B, Kidwell RP, Haller KB, Davis R: Senior executive adopt-a-work unit: a model for safety improvement. Jt Comm J Qual Patient Saf 2004, 30:59–68.</p><p>Pronovost PJ, Goeschel C: Improving ICU care: it takes a team. Healthc Exec 2005, 20:15–22.</p><p>Pronovost PJ, Weast B, Rosenstein B, Sexton B, Holzmueller CG, Paine L, Davis R, Rubin HR: Implementing and validating a comprehensive unit-based safety program. Journal of Patient Safety 2005, 1:33–40.</p><p>Pronovost PJ, Needham DM, Berenholtz S, Sinopoli D, Chu H, Cosgrove SE, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C: An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006, 355:2725–2732.</p><p>Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM: Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004, 32:2014–2020.</p

Cost and effectiveness thresholds for a catheter care bundle versus alternative infection control interventions.

<p>Cost and effectiveness thresholds for a catheter care bundle versus alternative infection control interventions.</p

Means (95% Bayesian credible intervals) of re-sampled changes to cost and QALY outcomes; 100 individuals per group.

<p>TC = Telephone Counselling.</p><p>UC = Usual Care.</p><p>RC = Real Control.</p><p>QALY = Quality Adjusted Life Year.</p

Total QALYs and costs over time.

<p>Total QALYs and costs over time.</p

Cost-effectiveness acceptability curves.

<p>Cost-effectiveness acceptability curves.</p