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iatrogenic- means medical transmission
Bull World Health Organ. 2002; 80(11): 859-70. Epub 2002 Dec 03
.Model-based estimates of risks of
disease transmission and economic costs of seven injection devices in
sub-Saharan Africa.
Ekwueme DU, Weniger BG, Chen RT.
National Immunization Program, Centers for Disease Control and
Prevention, Atlanta, GA, USA. dce3@cdc.gov
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 dollars 26.77 and US dollars 25.29, respectively, per injection from
the societal perspective. Disposable-cartridge jet injectors and
automatic needle-shielding syringes had the lowest costs, US dollars
0.36 and US dollars 0.80, respectively. Reusable-nozzle jet injectors
and auto-disable needle and syringes were intermediate, at US dollars
0.80 and US dollars 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.
