Economic burden of needlestick injuries among healthcare workers in China

Figures & data

Figure 1. Model structure. Abbreviations. NSI, needlestick injury; SP, source patient; HCW, healthcare worker.

Table 1. Percentage and transition probability inputs in the model.

Parameter	Value (%)	Source
Percentage of different situation as the pathway in model
SP identity known	0.734	^6
SP known who tested	0.84	KOLs
SP not infected, HCWs didn’t test	0.726	KOLs
SP infected, HCWs didn’t test	0.088	KOLs
SP known, HCWs didn’t test	0.394	KOLs
SP unknown, HCWs didn’t test	0.75	KOLs
SP unknown, HCWs had post-exposure prophylaxis (PEP)	0.25	KOLs
Transition probabilities prior to subsequent infections
SP infected HBV	0.072	^10
SP infected HCV	0.004	^11
SP infected HIV	0.001	^12
HCWs who are susceptible to HBV	0.298	^13
HCWs who are susceptible to HCV	0.988	^14
HCWs who are susceptible to HIV	1	^15
Blood-borne transmission rate of HBV	0.3	^9
Blood-borne transmission rate of HCV	0.018	^9
Blood-borne transmission rate of HIV	0.003	^9
HBV became chronic and generated cost	0.075	^16
HBV became liver cirrhosis and generated cost	0.03	^17
HBV became hepatic carcinoma and generated cost	0.005	^17
HCV became chronic hepatitis and generated cost	0.85	^16
HCV became liver cirrhosis and generated cost	0.025	^18
HCV became hepatic carcinoma and generated cost	0.001	^18
HIV became chronic and generated cost	1	^16

Table 2. Costs inputs in the model.

Costs	Value	Source
Unit cost of testing and PEP (RMB)
SP tested	184.25	^19, Unpublished data*
SP not tested	0	^19, Unpublished data*
No infection of SP, HCWs didn’t test	0	^19, Unpublished data*
No infection of SP, HCWs tested	147.23	^19, Unpublished data*
Infection of SP, HCWs didn’t test	0	^19, Unpublished data*
SP infected HBV, HCWs had PEP and followed up	233.5	Unpublished data*^a
SP infected HCV, HCWs had PEP and followed up	1,037.33	Unpublished data*^a
SP infected HIV, HCWs had PEP and followed up	1,974.12	Unpublished data*^a
SP not tested, HCWs didn't test	0	Unpublished data*
SP not tested, HCW tested	1,173.85	Unpublished data*^a
SP unknown, HCW didn't test	0	Unpublished data*^a
SP unknown, HCW tested	1,173.85	Unpublished data*^a
Subsequent infection cost (RMB)
Direct cost of chronic hepatitis B (/year)	7,469.27	^20^,^21
Indirect cost of chronic hepatitis B (/year)	5,287.96	^20^,^21
Direct cost of liver cirrhosis (/year)	44,750.1	^20^,^21
Indirect cost of liver cirrhosis (/year)	14,256.44	^20^,^21
Direct cost of hepatic carcinoma (/year)	101,388.9	^20^,^21
Indirect cost of hepatic carcinoma (/year)	37,596.7	^20^,^21
Direct cost of chronic hepatitis C (/year)	69,279.97	^22
Indirect cost of chronic hepatitis C (/year)	5,287.96	^20^,^21
Direct cost of HIV (/year)	12,100.01	^23
Indirect cost of HIV (/year)	5,025.68	^23
Annual salary in HCWs (CN#)	57,917	^24

* Compilation of healthcare service items and costs in Shanghai (2014), Chengdu (2016), Liaoning (2017), and Beijing (2017).

^a Fudan University Zhongshan Hospital, 2014. Standard operating procedure for occupational exposure treatment in healthcare workers.

Table 3. Other inputs in the model.

Parameter	Value	Source
Survival years of subsequent infections (years)
Chronic hepatitis B	29	^17
Liver cirrhosis	12	^17
Hepatic carcinoma	5	^17
Chronic hepatitis C	20	^17
HIV infection	22.5	^17
Productivity loss (hours)
SP tested and no infected, HCWs didn’t test (1a)	1.69	KOLs
SP tested and no infected, HCWs tested (2a)	3.33	KOLs
SP tested and infected, HCWs didn’t test (1b)	1.69	KOLs
SP tested and infected HBV, HCWs test (2b1)	16.29	KOLs
SP tested and infected HCV, HCWs test (2b2)	17.14	KOLs
SP tested and infected HIV, HCWs test (2b3)	115.38	KOLs
SP known, both SP and HCWs didn’t test (1c)	0	KOLs
SP known, SP didn’t test, HCWs tested (2c)	2	KOLs
SP unknown, HCWs didn’t test (1d)	0	KOLs
SP unknown, HCWs tested (2d)	2	KOLs
Incidence of NSIs
NSIs number per 1,000 HCWs	1032	^6
NSIs number per 1,000 doctors	866	^6
NSIs number per 1,000 nurses	1247	^6
NSIs number per 1,000 technicians	505	^6
NSIs number per 1,000 sanitation workers	678	^6
% of insulin injection-related NSIs	0.13	^25
% of blood collection-related NSIs	0.2	^25
% of transfusion-related NSIs	0.2	^25
Number of healthcare workers
Total number of HCWs in hospital	8007500	^26
Total number of doctors	2508400	^26
Total number of nurses	3241500	^26

Table 4. Economic burden per NSI.

Cost components	Total cost per NSI (¥)	The cost per NSI when SP had the infections (¥)
		Exposed to HBV	Exposed to HCV	Exposed to HIV
Direct cost of testing and PEP per NSI	319	397	1,238	2,175
Indirect cost of testing and PEP per NSI	61	411	474	3,168
Direct cost of infection per NSI	234	2,321	15,461	572
Indirect cost of infection per NSI	85	1,109	1,231	238
Total economic burden of per NSI	699	4,238	18,404	6,152

Table 5. Total economic burden of NSIs among HCWs.

Total economic burden of NSIs among HCWs	¥ (billions)
Economic burden of NSIs in nurses	2.8
Economic burden of NSIs in doctors	1.5
Economic burden of NSIs in China	5.8

Figure 2. One-way sensitivity analysis.

Figure 3. Probabilistic sensitivity analysis.

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