On the 3rd of September, the SafetyNet Economics of Safety Working Group held its third seminar via Zoom, focusing on the economic valuation of patient safety interventions. This session was part of an ongoing series aimed at exploring innovative approaches to healthcare economic evaluation, with a particular emphasis on Quality-Adjusted Life Years (QALYs) in patient safety.

Opening Remarks and Agenda Overview

The seminar commenced with a warm welcome from the host, who introduced the agenda for the day.

Presentation:

Valuing QALYs in Patient Safety: The central presentation was delivered by Dr. Richard Mattock, a Research Fellow in Health Economics at the Leeds Institute of Health Sciences. His talk centred on a proposal titled “The Valuation of QALYs in Patient Safety,” which is still under development. Unlike conventional research presentations, this seminar aimed to refine the proposal through collaborative input and explore potential partnerships. Dr. Mattock underlined the importance of contributions from patient safety experts and invited attendees to join as co-applicants or members of the steering group.

The Patient Safety Context: Patient safety, as defined by the NHS, encompasses the prevention of unintended harm during healthcare delivery. Dr. Mattock elaborated on various incidents under this umbrella, including medication errors, surgical mistakes, diagnostic inaccuracies, and unsafe treatment practices. Despite significant global commitments from organisations such as the NHS, NICE, and WHO, justifying the economic value of patient safety initiatives remains challenging. These interventions, while crucial, are often costly and may be deemed cost-effective only for frequent safety issues like infections and medication errors.

Case Study: Cost-Effectiveness of Patient Safety Interventions

Dr. Mattock illustrated the complexities of evaluating patient safety interventions with a case study on central venous catheter (CVC) insertions and the “WireSafe” intervention. This initiative aimed to prevent guide wire retention, an NHS Never Event. Although WireSafe was relatively low-cost per procedure, its overall cost-effectiveness was questioned due to the high cost per event prevented, ranging from £15,000 to £400,000. This case study highlighted the difficulty of justifying safety interventions in economic terms, particularly for rare events.

Unique Challenges in Patient Safety

Dr. Mattock addressed the unique challenges of evaluating patient safety compared to other medical treatments. He discussed the concept of externalities—such as the emotional and reputational impacts on clinicians and healthcare organisations—that must be considered in economic evaluations. Using a hypothetical example of two patients undergoing double limb amputations, he demonstrated how clinical negligence can lead to significant emotional distress, underscoring the need for evaluations that account for these broader impacts.

Methodological Focus of the Proposal

Dr. Mattock’s proposal seeks to refine methods for economic evaluations within the UK, using NICE’s cost-utility analysis framework. His goal is to develop methods that better capture the cost-effectiveness of patient safety interventions by evaluating both costs and health outcomes, ensuring that these initiatives offer value for money within healthcare systems.

Key Discussion Points and Takeaways

The Q&A session revealed several key insights:

• The perception of safety risks shifts notably after an adverse event.
• Personal experiences with adverse events influence the perceived value of safety interventions.
• Costing interventions that enhance overall system resilience presents unique challenges.
• Existing QALY measurement tools may need to be refined to capture psychological aspects of patient safety.

Looking Ahead: Collaboration and Future Research

As the series progresses, the NIHR Patient Safety Economics Interest Group continues to be a vital force in driving research that enhances patient safety while ensuring cost-effectiveness within healthcare systems.

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