Economic burden of major device-associated, acute-care hospital-onset infections among adults and children in the United States, 2007

 

Background:   The Department of Health and Human Services Action Plan To Prevent Healthcare-Associated Infections calls for using financial incentives to reduce infections in acute-care hospitals.  Using publicly available healthcare utilization data with device utilization ratios and infection rates from the National Healthcare Safety Network (NHSN), the number of acute-care, hospital-onset central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonias (VAP), and symptomatic catheter-associated urinary tract infections (SUTI) have recently been estimated for 2007.  However, national estimates of the economic burden of these infections are lacking.

Objective:  Using two consumer price indexes (CPI), develop national estimates for 2007 of the direct hospital costs attributable to device-associated infections in adults and children that have their onset in acute-care hospital wards and critical care units.

Methods:  The number of CLABSI, VAP, SUTI for 2007 were estimated in a separate analysis.  Attributable patient cost estimates for these infections were selected from those published in the peer- reviewed literature derived from systematic reviews or studies based on hospital-wide populations using micro-cost data or charges adjusted by cost-to-charge ratios.

Costs are adjusted to 2007 dollars using the CPI for all urban consumers (CPI-U) and the CPI for Inpatient Hospital Services (CPI-IHS).  The CPI-U is based on prices of goods and services in a typical market basket of urban consumers.  The CPI-IHS is based on prices of out-of-pocket expenditures by urban consumers for inpatient hospital services.  As the CPI-IHS tends to be higher than CPI-U, estimates were generated using each index.

Monte Carlo methods were used to estimate cost ranges by randomly sampling one value from the attributable cost and infection ranges in each of 99,999 simulations.  The 2.5^th and the 97.5^th percentile for each calculated cost defined a 95 percent credible interval.

Results:   The direct cost per infection site ranged from $130 million - $1.17 billion (CPI-U) and $147 million - $1.32 billion (CPI-IHS) for CLABSI; $142 million - $824 million (CPI-U) and $166 million - $912 million (CPI-IHS) for VAP; $31 million – $110 million (CPI-U) and $36 million - $131 million (CPI-IHS) for SUTI , and $457 million - $1.74 billion (CPI-U) and $524 million - $1.96 billion (CPI-HIS) in total direct hospital costs.

Conclusions: Acute-care hospital-onset, device-associated infections result in substantial costs that could be avoided with effective interventions.  Further efforts to estimate the costs of these infections that occur outside hospital settings are needed to assess total economic burden on the U.S. healthcare system.