Economic impact of revised rabies immunoglobulin administration protocol 2018 in the Emergency Department, Nakhon Pathom Hospital
DOI:
https://doi.org/10.14456/dcj.2019.28Keywords:
rabies, economic, protocol, immunoglobulinAbstract
In 2018 a new recommendation for rabies clinical practice guidelines was announced by the World Health Organization (WHO) and the Ministry of Public Health of Thailand (Thai MOPH). Nakhon Pathom Hospital has revised the rabies immunoglobulin administration protocol in August 2018 by directing the infiltration of immunoglobulin only into the wound site and its surroundings, the remaining immunoglobulin did not need to be injected intramuscularly and the immunoglobulin skin test was abandoned. Objective: To study the economic impact of revised rabies immunoglobulin protocol 2018 by considering the number of dose, cost and time saved as a result of the introduction of the new guidelines. Methods: Retrospective study on post-exposure rabies patients who received rabies immunoglobulin in the emergency department, Nakhon Pathom hospital, from January to December 2018. To compare the data before and after the introduction of these new clinical practice guidelines in August 2018. Results: In 2018, there were 4,805 post-exposure rabies cases. The patients who received rabies immunoglobulin were 2,967 cases, representing an average of 247 cases/month. Before the revision of rabies immunoglobulin administration protocol, an average of 2.6 vials of immunoglobulin were used per case, 2,121 Baht were spent per case, and 79.0 minutes were spent to treat each patient. After the protocol was revised, the figures were reduced to 1.1 vials/case for immunoglobulin use, 866 baht/case for cost, and 50.7 minutes/case for treatment duration. Throughout a period of five months, these new guidelines helped reduce the use of immunoglobulin by approximately 1,600 vials, saving an estimated 1,300,000 Baht in the cost of immunoglobulin, and reducing treatment duration by approximately 28.3 minutes/case. No serious adverse event (i.e. anaphylaxis) was reported and no human cases of rabies infection were reported in Nakhon Pathom Province. Conclusion: The implementation of revised rabies immunoglobulin administration protocol in 2018 was found to have resulted in a significant economic impact, leading to a statistically significant reduction in the use of rabies immunoglobulin doses and immunoglobulin costs by approximately 60.0%, as well as reducing treatment duration.
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