Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T15:23:10.023Z Has data issue: false hasContentIssue false

Economics and Preventing Hospital-Acquired Infection: Broadening the Perspective

Published online by Cambridge University Press:  02 January 2015

Nicholas Graves*
Affiliation:
Centre for Healthcare Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Queensland, Australia School of Public Health, Queensland University of Technology, Queensland, Australia
Kate Halton
Affiliation:
Centre for Healthcare Related Infection Surveillance and Prevention, Princess Alexandra Hospital, Queensland, Australia School of Public Health, Queensland University of Technology, Queensland, Australia
David Lairson
Affiliation:
School of Public Health, University of Texas Health Science Center at Houston
*
School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia ([email protected])

Abstract

Objective.

To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs.

Design.

We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years.

Setting.

Hypothetical modeling to incorporate the societal perspective.

Subjects.

A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement.

Intervention(s).

A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement.

Results and Conclusions.

We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade—off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Maynard, A. Is it worthwhile reducing hospital infection rates? In Williams, JD and Taylor, EW, eds. Infection in Surgical Practice. Oxford, England: Oxford University Press; 1992:119122.Google Scholar
2.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561566.Google Scholar
3.Drummond, MF, Jefferson, TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996;313:275283.Google Scholar
4.Plowman, RP, Graves, N, Roberts, JA. Hospital Acquired Infection. London: Office of Health Economics; 1997.Google Scholar
5.Drummond, MF, Davies, LF. Evaluation of the costs and benefits of reducing hospital infection. J Hosp Infect 1991;18 (Suppl 18):8593.Google Scholar
6.Cohen, DR. Economic issues in infection control. J Hosp Infect 1984;5 (Supplement A):1725.Google Scholar
7.Haley, RW. Cost-Benefit analysis of infection control activities. In Brachman, P and Bennett, J, eds. Hospital Infections. Philadelphia: Lippincott-Raven; 1998:249267.Google Scholar
8.Plowman, RP, Graves, N, Griffin, MAS, et al. The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198209.Google Scholar
9.Plowman, R, Graves, N, Griffin, M, et al. The Socio-Economie Burden of Hospital Acquired Infection. London:Public Health Laboratory Service; 2000.Google Scholar
10.Schulpher, M. The role and estimation of productivity costs in economic valuation. In: Drummond, M, McGuire, A, eds. Economic Evaluation in Health Care, Merging Theory With Practice. Oxford, England: Oxford University Press; 2000:94112.Google Scholar
11.Robinson, R. Cost-utility analysis. BMJ 1993;307:859–62.CrossRefGoogle ScholarPubMed
12.Williams, ASO. Economics of coronary artery bypass grafting. BMJ 1985;291:3269.CrossRefGoogle ScholarPubMed
13.Torrance, GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986;5:130.Google Scholar
14.Brazier, J, Deverill, M, Green, C, Harper, R, Booth, A. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999;3:1164.Google Scholar
15.Cookson, R. Willingness to pay methods in health care: a sceptical view. Health Econ 2003;12:891894.CrossRefGoogle Scholar
16.Saint, S, Chenoweth, C, Fendrick, M. The role of economic evaluation in infection control. Am J Infect Control 2001;29:338344.Google Scholar
17.Gold, MR, Siegel, JE, Russell, LN, Weinstein, MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.Google Scholar
18.Drummond, MF, Stoddart, GL, Torrance, GW. Methods for the Economic Evaluation of Health Care Programmes. 2nd ed. Oxford, England: Oxford University Press; 1997.Google Scholar
19.Drummond, MF, McGuire, A. Economic Evaluation in Health Care: Merging Theory With Practice. Oxford, England: Oxford University Press; 2001.Google Scholar
20.Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.Google Scholar
21.Briggs, AH. Handling uncertainty in economic evaluation and presenting the Results. In: Drummond, M, McGuire, A, eds. Economic Evaluation in Health Care, Merging Theory With Practice. Oxford, England: Oxford University Press; 2001:172241.Google Scholar
22.Donaldson, C, Currie, G, Mitton, C. Cost effectiveness analysis in health care: contraindications. BMJ 2002;325:891894.Google Scholar
23.Evans, C, Tavakoli, M, Crawford, B. Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: a critical appraisal. Health Care Manag Sri 2004;7:4349.Google Scholar
24.Garber, AM, Phelps, CE. Economic foundations of cost-effectiveness analysis. J Health Econ 1997;16:131.Google Scholar
25.Barry, HC, Ebell, MH, Hickner, J. Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Farn Pract 1997;44:4960.Google Scholar
26.Jacobson, JJ, Schweitzer, SO, Kowalski, CJ. Chemoprophylaxis of prosthetic joint patients during dental treatment: a decision-utility analysis. Oral Surg 1991;72:167–77.Google Scholar
27.Tsevat, J, Durand-Zaleski, I, Pauker, SG. Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Am J Public Health 1989;79:739–43.Google Scholar
28.Claxton, K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ 1999;18:341364.Google Scholar
29.Cooper, NJ, Sutton, AJ, Abrams, KR, Turner, D, Wailoo, A. Comprehensive decision analytical modelling in economic evaluation: a Bayesian approach. Health Econ 2004;13:203226.Google Scholar
30.Fenwick, E. Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ 2004;13:405415.Google Scholar
31.Cooper, BS, Medley, GF, Scott, GM. Preliminary analysis of the transmission dynamics of nosocomial infections: stochastic and management effects. J Hosp Infect 1999;43:131–47.Google Scholar
32.Cooper, BS, Lipsitch, M. The analysis of hospital infection data using hidden Markov models. Biostatistics 2004;5:223–37.CrossRefGoogle ScholarPubMed
33.Cooper, BS, Medley, GF, Stone, SP, et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004;101:102238.Google Scholar
34.Stone, WP, Larson, E, Kawar, LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control 2002;30:145–52.CrossRefGoogle ScholarPubMed
35.Everett, WD, Kipp, H. Epidemiologic observations of operating room infections resulting from variations in ventilation and temperature. Am J Infect Control 1991;19:277–82.Google Scholar
36.Chaudhuri, AK. Infection control in hospitals: has its quality-enhancing and cost-effective role been appreciated? J Hosp Infect 1993;25:16.Google Scholar
37.Fleming, CA, Balaguera, HU, Craven, DE. Risk factors for nosocomial pneumonia: focus on prophylaxis. Med Clin North Am 2001;85:1545–63.CrossRefGoogle Scholar
38.Mehtar, S. The continuing problem of ‘hospital staphylococci’: why? J Chemother 1994;6(Suppl 4):2531.Google Scholar