Economics and Preventing Hospital‐Acquired Infection: Broadening the Perspective • (original) (raw)

Modeling the Epidemiologic and Economic Impacts of Nosocomial Infection Prevention Strategies

2011

routine dispensing of home-based preoperative chlorhexidine bathing kits has the potential to prevent post-operative surgical site infections (SSIs). Our model suggests that preoperative bathing would have substantial economic value throughout a wide range of intervention implementation scenarios: patient compliance levels, cloth efficacies, costs, and SSI-attributable LOS, supporting the distribution of chlorhexidine cloths preoperatively. The public health significance is that decision makers can use the models described here to benchmark the test characteristics, potential target populations, and intervention implementation strategies to utilize in local infection prevention programs. A comprehensive approach including the interventions modeled here may help move towards the elimination of healthcare acquired infections. vi TABLE OF CONTENTS

A decade of investment in infection prevention: A cost-effectiveness analysis

American Journal of Infection Control, 2015

Background: Health careeassociated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs). Methods: Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central lineeassociated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled. Results: Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were 174,713.09forCLABSIand174,713.09 for CLABSI and 174,713.09forCLABSIand163,090.54 for VAP. The ICERs were 14,250.74perLYgainedand14,250.74 per LY gained and 14,250.74perLYgainedand23,277.86 per QALY gained. Conclusions: Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.

Exploring the real costs of healthcare-associated infections: an international review

Purpose: Healthcare-associated infections acquired a high degree of dissemination, being considered a serious public health problem and assumed as one of the most common adverse events associated with healthcare. They have a significant impact on health systems by increasing hospital expenses, and compromising the healthcare quality and effectiveness. Surgical site infections (SSI) are considered one of the most serious complications that can occur after an orthopaedic surgery. The aim of this study is to contribute to the development of a framework to analyse the costs of infections related to hip and knee arthroplasties. Methods: A literature review was conducted on databases, and articles published between January 2005 and April 2016 were searched. Findings: A total of 14 articles met the inclusion criteria. Costs were grouped in hospitalization and treatment dimensions. For hospitalization, the indicators were the length of stay (LOS) and/ or monetary costs; For treatment, the indicators were number of surgeries and LOS, or monetary costs. We observed that LOS is the most commonly used to estimate SSI direct costs. Patients who developed hip or knee arthroplasty infections remained in hospital 2.5-3 times longer and incurred hospital costs almost three times higher, when compared with an uninfected patient.

Systematic review of economic analyses of health care-associated infections

American Journal of Infection Control, 2005

Background: Economic evidence is needed to assess the burden of health care-associated infections (HAIs) and cost-effectiveness of interventions aimed at reducing related morbidity and mortality. The objective of this study was conducted to assess the quality of economic evaluations related to HAI and synthesize the evidence. Methods: A systematic review of research published between January 2001 and June 2004 was conducted. Quality of the publication was estimated using a Likert-type scale. All cost estimates were standardized into a common currency. Descriptive statistics and a logistic regression were conducted to identify predictors of high quality. Results: 70 studies were audited. There was wide variation in these cost estimates. Publications estimating the cost attributable to an infection were almost 7 times more likely judged to be of higher quality than studies of the cost of interventions (P , .05). Papers in which the authors stated the perspective (hospital or societal) were twice as likely to be judged as being of high quality (P , .05). Conclusion: There are more publications and growing interest in estimating the costs of HAI. However, the methods employed vary. We recommend (1) the use of guidelines for authors and editors on conducting an economic analysis, (2) development of more sophisticated mathematical models, and training of infection control professionals in economic methods. (Am J Infect Control 2005;33:501-9.)

The Impact of Surgical Site Infection to the Health Care Cost

International Journal of Public Health Science (IJPHS)

Surgical Site Infection (SSI) is the most common cause of nosocomial infections. The incidence of SSI is ranging between 14 - 16% of the entire incident of nosocomial infections in hospitalized patients. The objectives of this study were to determine the relationship between knowledge, attitude, infrastructure and behavior of health personnel to prevent SSI and to determine the amount of additional costs for hospital care as a result of SSI. This study used a mixed method research. Quantitative research conducted with descriptive analytic design with cross sectional approach. Quantitative data was analyzed by univariate and bivariate analysis. Qualitative research was used to measure additional cost due to SSI. Health personnel showed good knowledge about SSI prevention (89.6%), good attitude towards SSI prevention (57%), assessed good for hospital infrastructure (93.8%), but only 55.2% showed good behavior to prevent SSI. There were no relationship between knowledge and attitudes o...

Effect of nonpayment for preventable infections in U.S. hospitals

The New England journal of medicine, 2012

In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown.

Economic Analysis of the Prevention and Control of Nosocomial Infections: Research Protocol

Frontiers in Public Health, 2021

Background: Nosocomial infections (NIs) are among the main preventable healthcare adverse events. Like all countries, Canada and its provinces are affected by NIs. In 2004, Ministry of Health and Social Services (MSSS) of Quebec instituted a mandatory surveillance NI program for the prevention and control (NIPC) in the hospitals of the province. One target of the MSSS 2015–2020 action plan is to assess the implementation, costs, effects, and return on investment of NIPC measures. This project goes in the same way and is one of the first major studies in Canada to evaluate the efficiency of the NIPC measures. Three objectives will be pursued: evaluate the cost of implementing clinical best practices (CBPs) for infection control; evaluate the economic burden attributable to NIs; and examine the cost-effectiveness of the NIPC by comparing the costs of CBPs against those of NIs.Methods: This project is based on an infection control intervention framework that includes four CBPs: hand hy...

Economic burden of healthcare-associated infections: an American perspective

Expert Review of Pharmacoeconomics & Outcomes Research, 2009

Annually, approximately 2 million patients suffer with healthcare-associated infections (HAIs) in the USA, and nearly 90,000 are estimated to die. The overall direct cost of HAIs to hospitals ranges from US$28 billion to 45 billion. While the range is wide, HAIs are clearly expensive. In addition, most HAIs are thought to be preventable; however, published guidelines are not congruent. Important policy changes include mandating hospitals to publically report HAI rates and a federal pay-forperformance measure that will no longer allow Medicare to pay more for patients with HAIs. Further rigorous economic evaluations of specific interventions, as well as on evaluations of the policies, are required.