Health care-associated infections (HAIs) account for a large proportion of the harms
caused by health care and are associated with high costs. Better evaluation of the
costs of these infections could help providers and payers to justify investing in
prevention.
To estimate costs associated with the most significant and targetable HAIs.
For estimation of attributable costs, we conducted a systematic review of the literature
using PubMed for the years 1986 through April 2013. For HAI incidence estimates, we
used the National Healthcare Safety Network of the Centers for Disease Control and
Prevention (CDC).
Studies performed outside the United States were excluded. Inclusion criteria included
a robust method of comparison using a matched control group or an appropriate regression
strategy, generalizable populations typical of inpatient wards and critical care units,
methodologic consistency with CDC definitions, and soundness of handling economic
outcomes.
Three review cycles were completed, with the final iteration carried out from July
2011 to April 2013. Selected publications underwent a secondary review by the research
team.
Costs, inflated to 2012 US dollars.
Using Monte Carlo simulation, we generated point estimates and 95% CIs for attributable
costs and length of hospital stay. On a per-case basis, central line-associated bloodstream
infections were found to be the most costly HAIs at $45,814 (95% CI, $30,919-$65,245),
followed by ventilator-associated pneumonia at $40,144 (95% CI, $36,286-$44,220),
surgical site infections at $20,785 (95% CI, $18,902-$22,667), Clostridium difficile
infection at $11,285 (95% CI, $9118-$13,574), and catheter-associated urinary tract
infections at $896 (95% CI, $603-$1189). The total annual costs for the 5 major infections
were $9.8 billion (95% CI, $8.3-$11.5 billion), with surgical site infections contributing
the most to overall costs (33.7% of the total), followed by ventilator-associated
pneumonia (31.6%), central line-associated bloodstream infections (18.9%), C difficile
infections (15.4%), and catheter-associated urinary tract infections (<1%).
While quality improvement initiatives have decreased HAI incidence and costs, much
more remains to be done. As hospitals realize savings from prevention of these complications
under payment reforms, they may be more likely to invest in such strategies.