Should the UK government's deep cleaning of hospitals programme have been evaluated?

Background: In September 2007, the UK government announced a £57.5m programme of `deep cleaning' for every NHS hospital in England. The programme was met with some scepticism and this paper provides an outline economic evaluation of the programme. Methods: We use information on costs of the programme, the opportunity cost of closing wards for cleaning and cost savings and health gains resulting from cleaning to model the reduction in the annual hospital acquired infection (HAI) rate required for the programme to be cost-effective. We compare our results with the potential headroom available, based on the available evidence and the beliefs of 15 experts. Findings: If wards are closed for two days for cleaning, an annual HAI reduction of 7.8% (21,000 fewer non-fatal infections and 355 fewer deaths nationwide) would be required at a cost-effectiveness threshold of £30,000 per Quality Adjusted Life Year. This figure does not compare favourably with the effectiveness estimates of <1% obtained from the available evidence on cleaning and the pooled prior beliefs of 15 experts. Interpretation: Our analysis shows that as it is very unlikely the deep cleaning programme would have been cost-effective, a full evaluation would not have been a good use of public funds.