The economics of using sharp safety-engineered devices

Pete Phillips and Joanna Ford, SMTL

October 2008


A range of sharp safey-engineered devices are available on the market designed to protect the user from a sharps injury following use. This report aims to summarise the economic considerations of introducing 'sharp safety' devices into the work place and attempts to demonstrate how the costs of these changes can be calculated.

Safety devices for the prevention of sharps injuries are designed to prevent re-use and injury to the user. As a result, they contain additional mechanisms and complex parts which can result in them being significantly more expensive than their conventional counterparts. However, if the use of these devices leads to a reduction in needlestick injury rates, this may result in associated cost savings.  The cost of using the new devices compared to the savings they may produce can help the NHS understand the economics involved in introducing the devices.  

Calculating costs for the prevention of injuries is not straightforward for a number of reasons:

For these reasons, such calculations are only estimates. Finally and perhaps most importantly, factors such as pain, worry and stress caused by needlestick injuries from contaminated sharps cannot be easily or readily quantified. Therefore, weighing up the cost of needle protection devices against the reduced chance of health care workers sustaining sharps injuries and contracting blood borne viruses is not a simple economic exercise.

The costs of the following  should be considered in any financial analysis by health care workers:

Device cost comparisons

The following table compares the prices (per item) of some conventional devices with 'safer' alternatives (information provided by manufacturers). Please note that the prices are approximate.

Conventional Device

 Safety Device Alternatives

Syringe (Monoject) and needle, Tyco 3p

NMT safety syringe 36p


Point syringe 60p


Point syringe 27p

BD Eclipse


BD Integra



IV Catheter (Venflon), BD 62p

J+J Protectiv Plus £1


Protectiv Acuvance 2 £1.60

NMT Vaxcess £1.21


Vasofix safety




Safelon Pro


Needle and suture, Ethicon £2

J+J Ethiguard blunt taperpoint







Butterfly, Abbott Labs 23p

ICU Med. Punctur guard 72p

Terumo Surflow winged infusion set 38p






Blood collection needle, Greiner 4.7p

ICU Med.

Punctur guard 23p

Safety lock (Vanish Point) 35p





Blood collection set, Greiner 27p

Terumo Surshield sampling set







Blood lancet, Greiner 10p

Owen Mumford Unistik 2









Which costs should be examined ?

i. Cost of the device

The unit price of the device is multiplied by the usage per year (the number of devices used by the Hospital/Trusts should be available from procurement). For safety devices, it is usual to calculate the cost using the same annual usage as the conventional device. This may not necessarily be accurate as the safety-mechanism prevents re-use or re-siting of the device compared to non-safety devices, and therefore usage may increase with the safety devices. Therefore  an individual hospital or Trust may wish to examine potential changes in usage levels in more detail and incorporate them into the financial analysis.

ii. Cost of the needlestick injury

To calculate the cost of needlestick injury from conventional devices, multiply the number of injuries sustained per year by use of the conventional device (usually available from Infection Control or Occupational Health Departments) by the estimated costs incurred per injury (information for injury costs are estimated in the literature. Note that the costs for high risk and low risk injuries are significantly different).

For safety devices, multiply the cost of injuries (as above) by the  assumed reduced chance of sustaining an injury with the safety device. For example, if the the safety device has been shown to reduce needlestick injury by 60%, the expected injury costs should be 40% of the costs incurred when conventional devices were used.

iii. Total cost

For both the conventional and safer devices, add the cost of the device to the cost of injury. The difference between totals will give you an estimate of the changes in cost that will result from the introduction of the safer device.

Breakdown of NSI costs - an example

The information within the following tables has been taken from the 'Becton Dickinson financial modeling tool for safety'. The first table details the costs of a low-risk injury.


Cost estimate


Nursing time


NHS Careers Pay and Benefits

Occupational health time


Costs of Health and Social care 1999. Personal services Research Unit

Hepatitis B vaccination


D Francis. J. Occ. Med. 1991

PEP clinic time and Dr. consultation


A Netten. Personal services Research unit

Laboratory time


Working Well Initiative, NHS, 2001

Blood tests


(average of Hep. B, Hep. C and HIV test)

A. Reutter J. of Adv. Nursing 1997



Working Well Initiative, NHS, 2001

Management time


Working Well Initiative, NHS, 2001

Accident investigation health and safety


(average of IC nurse and consultant

Working Well Initiative, NHS, 2001

Time away from ward


Working Well Initiative, NHS, 2001

Occupational health time (follow up)


A. Netten, Personal services Research unit

The following table details some of the additional costs of a high risk injury


Cost estimate


Post exposure prophylaxis treatment



UK CMO Expert advisory group on AIDS, 2000

Hepatitis B treatment



Hepatitis C treatment



HIV treatment-asymptomatic phase


NPMS steering group

HIV treatment-symptomatic phase


NPMS steering group

Treatment of AIDS


NPMS steering group

Basic cost calculations

The calculation for both conventional devices and safety devices is summarised in its simplest form:

Cd + Ci = Ct


Compensation claims

The cost packages here do not include compensation costs which are increasingly a major feature following injuries in the workplace. In our own Trust, needlestick injury (without sero-conversion) claims have lead to compensation costs of between £1000 and £14,000 per case (data provided by Trust Health and Safety department). If sero-conversion took place as a result of a sharps injury, the compensation claims would be far greater.

Examples of cost calculations

i. Peripheral IV catheters

The following table calculates the approximate cost of introducing the J+J Protectiv Plus safety catheter. The following examples in this section are based on one of the Welsh NHS Trusts. Calculations are based on actual usage and injury data for the Trust in question. The 76% reduction in injury with the safety catheter has been suggested, based on a number of studies. The cost of low-risk injury (£311.38) has been taken from BD's costing package which BD state is based on literature. The results were produced when using the BD financial modelling tool.


Conventional device


Safety device

Cost of device purchase

Usage x cost of device 47,546 x 62p =


Usage x cost of device 47,546 x £1 =


Cost of needlestick injury

No. injuries x estimated cost of low risk injury 7 x £311.38 =


Cost of injury x % reduction in injury £2179.66 x 0.24 (76% reduction in injury) =


Total cost



This costing exercise estimates that, with a predicted injury decrease of 76%, introducing the safety IV catheter will cost the Trust in question an extra £17,000 per annum (approximately).

The J+J costing package uses injury costs presented in the Scottish Report (Paterson and Elder 2005). Cost of injury is divided into the following bands:

In the same way as the previous tables, the following tables calculate the approximate cost of introducing the J+J Protectiv Plus safety catheter into the same Welsh NHS Trust, using the same usage details, under a variety of scenarios depending on the severity of injury.

Scenario 1 - When all injuries are low risk


Conventional device

Safety device

Cost of device purchase



Cost of needlestick injury



Total cost



Scenario 2 - When one of the injuries is a downstream injury


Conventional device

Safety device

Cost of device purchase



Cost of injury



 Total Cost



Scenario 3 - When one of the injuries is higher risk (i.e. the source patient is HIV positive)


Conventional device

Safety device

Cost of device purchase



Cost of needlestick injury



Total Cost



In all the scenarios above, the safety device is more expensive to introduce than the conventional device but the cost of conventional devices increase as the injury costs increase. Such an exercise highlights the benefits of using such a software package, as the cost of introducing safety devices can be evaluated under different scenarios.

ii. Needles and syringes

The following table compares the cost of using conventional syringe and needles with the cost of the BD Eclipse safety syringe (needle with shield) using the BD costing package. There is no concrete data on reduction in NSI with needle and syringes so a reduction in injury of 75% was chosen to illustrate potential cost savings. The following table shows the cost implications when one out for the 40 previous injuries sustained from the use of syringes and needles was high risk:

The results show that introducing the new safer device could incur significant costs per year even though the cost of injury could be reduced considerably. Syringes and needles are the most used items and cause the most injuries. Some safety syringes cost over ten times as much as the conventional devices. Please note: since writing this report we have been made aware of needle shield/guards available which cost little more than their conventional counterparts.  


Conventional device

Safety device

Cost of device purchase

2701,000 x 3p =


2701,000 x 14p =


Cost of needlestick injury

39 x £311.38 1 x £15,171 =


£27,314 x 0.25 =


Total cost



iii. Butterfly devices

The following tables compare the cost of using the conventional butterfly with the cost of 2 types of safety butterfly. The reduction in injury with the safer device was calculated as 52% (taken from an American study where a similar safety device was evaluated (Mendelson et al., 2003)). Cost of low risk needlestick injury was taken from BD costing package.



Conventional device

Safety device (Surflow)

Safety device (Punctur-guard)

Cost of device purchase

8244 x 23p = Â£1,896.12

8244 x 38p = Â£3,132.72

8244 x 72p = Â£5,935.68


Cost of needlestick injury

25 x £311.38 =£7,784.50

£7784.5 x 0.48 = Â£3,736.56

£7784.5 x 0.48 = Â£3,736.56

Total cost




The results show that if the cheaper of the 2 safety devices were purchased, nearly £3000 is saved because the cost of needlestick injury is fairly high. If the more expensive safer device were purchased, the price would be approximately the same.

iv. Blood collection needles

The following tables compare the cost of using the conventional blood collection needle with the cost of 2 types of safety blood collection needle. The reduction in injury with the safer device was calculated as 76% (taken from a study where the Punctur-guard blood collection needle was evaluated (Public Health Service 1997). Cost of low risk needlestick injury was taken from BD costing package.


Conventional device


Safety device (Puncture-guard)

Safety device (Vanishpoint)

Cost of device purchase

194,500 x 4.7p = Â£9,141.50

194,500 x 23p = Â£44,735.00

194,500 x 35p = Â£68,075.00

Cost of needlestick injury

8 x £311.38 = Â£2,491.00

£2491.04 x 0.24 = Â£597.85

£2491.04 x 0.24 = Â£597.85

Total cost





The results show that the cheapest of the 2 safer devices would cost an extra £33,000 to introduce (with an approximate injury decrease of 76%).

IMPORTANT: None of the above scenarios account for injury/compensation costs after a needlestick injury results in transmission of a blood borne disease


Sharps injuries in health care settings are stressful for the user, can potentially cause blood borne infections and can incur significant costs to the NHS, especially if this results in transmission of a blood borne disease. Sharp safety devices are designed to prevent sharps injury following use and may be beneficial in reducing injury rates. Although they usually cost more than their conventional counterparts, overall cost savings are possible if injury rates decrease or transmission of blood borne infections are prevented.

Caveat: The figures in the cost calculations were provided in 2003 and are for reference only. Some references cited from the financial modelling tools are not readily available.


Brewer S. Needlestick awareness; working well campaign. 2001. Infection Control :The Medical Book; 163-164

Laufer F, Chiarello L. Application of cost-effectiveness methodology to the consideration of needlestick-prevention technology. 1995 American Journal of Infection Control:22 (2); 75-82

Mendelson M, Lin-Chen B, Bailey E, Kogan G, Goldbold J. Evaluation of a safety resheathable winged steel needle for prevention of percutaneous injuries associated with intravascular-access procedures among healthcare workers. 2003. Infection control and hospital epidemiology:24(2);105-112.

Paterson C and Elder A (2005). Safer sharp Devices: An evaluation of utility in NHS Scotland. A report for the Occupational Health and Safety Strategy Implementation group NHS Scotland. Scottish Executive Edinburgh.

Public health service. 1997. Evaluation of safety devices for preventing percutaneous injuries among health-care workers during phlebotomy procedures. MMWR:46 (2) ;21-25