Blog | Monday, September 9, 2013

QD: News Every Day--Five costliest nosocomial infections cost $10 billion annually

Central line infections are the costliest of nosocomial infections, with Clostridium difficile being the fourth-most costliest, a study found.

To estimate costs associated with the most significant and targetable infections, researchers did a literature search on U.S.-based studies done from 1986 through April 2013, deriving 26 studies on health care-associated infections of adult inpatients and then applying incidence estimates from the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC). Costs were translated to 2012 dollars.

Results appeared online Sept. 2 at JAMA Internal Medicine.

A Monte Carlo simulation derived attributable costs and length of hospital stays on a per-case basis:
• central line-associated bloodstream infections, $45,814 (95% confidence interval [CI], $30,919-$65,245)
• ventilator-associated pneumonia, $40,144 (95% CI, $36,286-$44,220),
• surgical site infections, $20,785 (95% CI, $18,902-$22,667),
C. difficile infections, $11,285 (95% CI, $9118-$13,574), and
• catheter-associated urinary tract infections, $896 (95% CI, $603-$1189).

The five infections tallied $9.8 billion (95% CI, $8.3-$11.5 billion) annually, with surgical site infections contributing the most (33.7%) to overall costs, 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%).

The report called for increased federal support to evaluate prevention approaches, encourage innovation to enhance surveillance

The authors wrote, “While enhancing our ability to prevent SSIs (surgical site infections), CMS (Centers for Medicare and Medicaid) could expand the list of procedures for which it will not reimburse for a higher-charge DRG (diagnosis related groups) due to SSIs and encourage private payers to implement nonpayment strategies. However, it should be noted that the consequences of such policies have not been fully evaluated, and there is a need to assess whether these initiatives might have substantial unintended effects.”

An editorial commented that while the priority for research into health care-associated infections is to save lives, such studies also help health care administrators prioritize preventive efforts.

“Not paying for hospital-acquired infections or errors is an important part of the movement toward paying for quality, not quantity, of care,” the editorial stated. “As physicians, we should embrace the opportunity that these new payment schemes offer for bringing higher-quality care—including fewer infections—to our patients.”