“There’s always a lot more disease and patients than we can afford to look after, so we can’t afford to put resources into things that aren’t good value for money or cost-effective. Value for money in healthcare is a very important theme and I think anybody leading healthcare that is allocating resources, or managing a department or group, should be aware of this principle of good value for money or good return on investment,” says Professor Nicholas Graves, Deputy Director of the Programme in Health Services & Systems Research at Duke-NUS Medical School and the SingHealth Duke-NUS Health Services Research Institute.
With research interests covering health economics and how health services can be improved at low cost or even cost savings, Prof Graves is keenly aware of the numerous competing priorities for hospital budgets, and thus the importance of identifying the ones that deliver the best outcomes or returns.
This is especially true for hospital infection prevention control, which normally has a bundled approach comprising many different aspects such as disinfection, PPE or isolation. It can be difficult for hospitals to find out how one intervention or product would impact the overall effectiveness of IPC, which is key to guiding informed purchasing decisions.
Teasing out the impact of temporary isolation rooms
To that end, Prof Graves led a study to evaluate the cost-effectiveness of a single investment – that of temporary single isolation room, Rediroom – in preventing healthcare-associated infections (HAIs).
“Given the emergence of this new temporary isolation room solution, I think it’s important to ask the question: Would Rediroom be a sensible thing to do in the fight against HAIs from an effectiveness and cost-effectiveness point of view?” says Prof Graves.
The team performed financial modelling based on data from two UK NHS hospitals, tracking the impact of such temporary rooms on cost per life-year gained (an outcome measure that calculates the monetary cost of a particular piece of equipment for each year of life gained for patients).
For temporary isolation rooms, the team found that the mean expected cost per life-year gained is £5,829, which is “quite comfortably below the threshold for government decision making groups about making new investments in healthcare”, says Prof Graves. He cited the example of UK’s National Institute for Health and Care Excellence (NICE), which tends to fund programmes that cost below £13,000 per life-year gained.
Prof Graves noted that while hospitals do have to bear an increase in costs, temporary isolation rooms can lead to cost savings down the road that would offset some of those costs, together with a reduction in the number of infections and number of deaths, which are crucial health outcomes.
The model assumes that adoption of temporary isolation rooms would reduce the risk of HAIs by about 30%, a figure agreed upon by clinical experts in the research team. However, based on the understanding of the mechanics of infection spread – by droplet, touch or interactions – there is “good reason to believe that a room that can effectively isolate particularly high-risk patients and keep them from the others, would have a large impact on rates of HAIs”, explains Prof Graves.
The role that temporary isolation rooms can play
In the current pandemic, temporary isolation rooms can serve as a way to ramp up capacity easily, safely and relatively cheaply, as compared to permanent or semi-permanent isolation structures.
“We’ve had to basically reconfigure our hospitals to be sort of semi- isolation rooms, but that has been done at vast expense,” says Prof Graves, pointing to costly and disruptive works to build temporary dividers or sheeting between patients, which are not purpose-built for isolation.
“I also think there’s a large burden on healthcare staff in terms of stress, discomfort and inconvenience,” he adds.
“For patients, it is scary enough going to hospital in the first place, but then being put into a healthcare system where everybody is stressed out and panicked – I don’t think it’s an ideal way to run a health system.”
Temporary isolation rooms can also be useful in non-pandemic times, considering the rise of antibiotic resistance makes many HAIs difficult and expensive to treat.
“(Such rooms) just enable us to very quickly remove a high-risk person from the population… if they’re colonised or infected with a high risk organism, then they can be instantly isolated.
“Not many of our hospitals have single rooms – they do have some isolation capacity, but if those are filled up, then temporary isolation rooms like Rediroom are able to be rapidly deployed. I think that is a quite a useful thing for hospitals to be able to do, when you think about the consequences of an outbreak.”
Further studies to be conducted
Looking ahead, Prof Graves and his team have conducted some research on this topic in Australian facilities, and are working on a paper to be published in the coming months.
He is also looking at carrying out such studies in the Southeast Asian setting, in particular Singapore, where there is a good amount of data available.
“Rates in Singapore and some other Southeast Asian countries, especially of resistant organisms, are quite high and growing. So I think we’ve built a nice starting point to look at the value of Rediroom in different jurisdictions,” notes Prof Graves.
“My feeling is that if it’s good value for money in the NHS, which has got quite good infection control, it would be a stronger argument in countries which have higher rates of healthcare-acquired infection.”
The research can be complemented by data collected by healthcare providers with such products, he suggests. Through real-world trials, valuable information can be derived for evaluation of temporary isolation rooms, even at small scales.
“If a number of small studies are done, then there’s always an opportunity to, later on, pull those results to try and get a stronger result. So I think a real-world research effort around the effectiveness would be great.”
Access the full research paper by Prof Graves and his team here.
About Professor Nicholas Graves
Prof Graves is the Deputy Director of the Programme in Health Services & Systems Research at Duke-NUS and the SingHealth Duke-NUS Health Services Research Institute. His areas of knowledge include health economics, health services research, decision making and cost-effectiveness. He is interested in projects that show high and low-value care, as well as the processes around implementing new policies.
His major focus is on showing how health services can be improved at low cost, or even improved with cost savings. He enjoys collaborating with clinicians who wish to improve the performance of health services.
Prof Graves has made contributions of international significance, publishing over 250 articles in top-ranking peer reviewed journals such as JAMA, BMJ, AIDS, Health Economics, Clinical Infectious Diseases, Lancet Infectious Diseases, The Journal of Infectious Diseases and Emerging Infectious Diseases.