(P2-16) Study to Assess the Cost Effectiveness of Re- Use of Expensive Disposable Items in a Neurosurgery Intensive Care Unit

Abstract

Background

Certain disposable items such as Percutaneous Tracheostomy (PT) sets and intracranial pressure (ICP) monitoring sets are expensive and a major drain on resources of public funded hospitals.

Aims

To assess the use and cost-effectiveness of reusing expensive disposables (PT& ICP sensor) in a neurosurgery intensive care unit (ICU). Another objective was to assess the importance of bedside Tracheostomy and ICP insertion in an ICU rather than in OT.

Methods

An observational, retro-prospective study was done from January 2008 to November 2010 in the neurosurgical department of JPN Apex Trauma Center. Retrospective data on surgeries performed in Neurosurgery OT were taken for the year 2008 and following introduction of PT and bedside ICP monitoring sets in ICU, prospective data were collected from November 2009 in the neurosurgery ICU. Each set was tagged according to number of times used. A procedure book was maintained, in which each case along with the set used was mentioned.

Results

Of the 1209 surgeries performed in the neurosurgical OT in 2008–2009, 257 were minor procedures (238 open tracheostomy and 19 ICP transducer placements). In 2009–10, 236 percutaneous tracheostomies were performed in the ICU. Of these, 79 (33.4%) were new and 157 (66.5%) were re-used sets. The cost of a new PT set is Rs 15,000. With re-use, the average price per set came down to Rs 5,033. In the same period, 231 disposable ICP transducers were placed with an average of 19 cases per month (range 5–28). Of these, 142 (61%) were new ICP sets and 97 (42%) were ethylene oxide (ETO) sterilized. The cost of new ICP set is Rs 35,000. With re-use, the average price per set came down to Rs 21,515.

Conclusion

Nearly 40% of minor procedures are now excluded from the Neurosurgery OT statistics, as they are being performed in the ICU. This study shows that expensive disposable items can be re-used effectively, bringing immense cost savings to hospitals.