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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 1  |  Page : 1-4

Economics of preventing healthcare-associated infections


1 Department of Microbiology, A J Institute of Medical Sciences and Research Centre, Mangalore, Karnataka, India
2 A J Hospital and Research Centre, A J Institute of Hospital Management, Mangalore, Karnataka, India

Date of Web Publication13-Aug-2019

Correspondence Address:
Dr. Roopa Bhandary
Department of Microbiology, A J Institute of Medical Sciences, Kuntikana, Mangalore - 575 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_1_19

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  Abstract 


Introduction: Healthcare-associated infections (HCAIs) contribute to significant morbidity, mortality and economic costs. There are many different ways of preventing hospital infections. An effective infection control programme (ICP) should be a cost-effective medical intervention. Hence, the current study was undertaken to determine the cost-effectiveness of the ICP for the years 2015–2016 and 2014–2015 in comparison to 2013–2014.
Methodology: This study was conducted in a 400-bedded super speciality hospital. The infection control budget for the years 2013–2014, 2014–2015 and 2015–2016 was calculated. Incremental cost-effectiveness ratio (ICER) was calculated as the difference in cost between two interventions divided by the difference in health benefit obtained.
Results: The total expense incurred on the ICP in the year 2013–2014 was Rs. 1,640,162. In the years 2014–2015 and 2015–2016, the ICP was upgraded with an incremental budget of Rs. 816,208 and Rs. 1,025,730, respectively. There was a significant reduction in HCAI rates in the years 2014–2015 and 2015–2016. The ICER for the years 2014–2015 and 2015–2016 was 68,017.33 and 60,337.05, respectively. Based on the analysis, the ICP for the year 2015–2016 was more cost-effective.
Conclusion: The incremental budgeting for the new ICP for the year 2015–2016 proved to be a more efficient and cost-beneficial intervention for infection control.

Keywords: Cost-effective, healthcare-associated infection, incremental cost-effectiveness ratio


How to cite this article:
Bhandary R, Marla A, Anita K B. Economics of preventing healthcare-associated infections. J Patient Saf Infect Control 2019;7:1-4

How to cite this URL:
Bhandary R, Marla A, Anita K B. Economics of preventing healthcare-associated infections. J Patient Saf Infect Control [serial online] 2019 [cited 2019 Oct 18];7:1-4. Available from: http://www.jpsiconline.com/text.asp?2019/7/1/1/264394




  Introduction Top


As per the WHO report, nearly 1.4 million people acquire infection in the hospital every day. The rate of healthcare-associated infection (HCAI) is higher in developing countries, with the prevalence rate ranging between 5% and 19%. Research shows that through appropriate interventions, 70% of the HCAI can be prevented.[1] New recommendations and evidence-based practices have been put forth to reduce the number of HCAI. However, the cost–benefit ratio with the adoption of these strategies is not clear.[2] Cost-effective analysis can prove beneficial to choose the most effective intervention to reduce the HCAI.[3] In India, not many studies have been done on the cost-effectiveness of the infection control programme (ICP).

Hence, the current study was undertaken to analyse the effectiveness of the investments for the ICP on the rates of HCAI and to compare the incremental cost-effectiveness ratio (ICER) of the ICP for the financial years 2015–2016 and 2014–2015 considering the financial year 2013–2014 as status quo.


  Methodology Top


Study design

This was an observational study.

This study was conducted in a 400-bedded super speciality hospital. The ICP for the years 2014–2015 and 2015–2016 was upgraded as a part of the yearly risk reduction goals.

Surveillance for the HCAI – catheter-associated urinary tract infection (CAUTI), central line-associated blood stream infections (CLABSI) and ventilator-associated pneumonia (VAP) was done by the infection control team as per the CDC guidelines.

The infection control budget for the years 2013–2014, 2014–2015 and 2015–2016 was calculated.

The budget allocation for each section of the ICP was calculated separately. The ICER for the financial years 2014–2015 and 2015–2016 was calculated.

Statistical analysis





Infection control model for the year 2013–2014 was considered to be the status quo for the above calculations.

(Ref: Part V: Cost-effectiveness Analysis. Outcomes in Natural Units: The Fifth of a five-part series. Centre for Disease Control and Prevention, USA [Updated date: Not known; cited: 18 April 2018]. https://www.cdc.gov/dhdsp/evaluation_resources/./Economic-Evaluation-Part 5.pdf).

Data were analysed using SPSS version 16 (SPSS Inc, Chicago). Chi-square test, t-test and P value were calculated for a comparative analysis of HCAI. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] represents the annual budget for the years 2013–2014, 2014–2015 and 2015–2016 and the expenditure/bed for the respective years.
Table 1: Annual budget and expenditure/bed

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[Table 2] depicts the analyses of the budget for the years 2013–2014, 2014–2015 and 2015–2016 to know the percentage expenditure for each category of ICP.
Table 2: Categories and percentage expenditure for each category

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[Figure 1], [Figure 2], [Figure 3] depict the ICP and the expenditure utilised in the differentsectors in the financial years 2013–2014, 2014–2015 and 2015–2016.
Figure 1: Infection control model for the year 2013–2014

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Figure 2: Infection control model for the year 2014–2015

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Figure 3: Infection control model for the year 2015–2016

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[Table 3], [Table 4], [Table 5] show the analysis of CAUTI, CLABSI and ventilator-associated pneumonia (VAP) rates for the years 2013–2014, 2014–2015 and 2015–2016, respectively.
Table 3: Comparison of catheter-associated urinary tract infections

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Table 4: Comparison of central line-associated blood stream infections

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Table 5: Comparison of ventilator-associated pneumonia

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[Table 6] shows that there was a significant reduction in the rate of HCAI in the year 2015–2016.
Table 6: Healthcare-associated infections rate over the 3 financial years

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[Table 7] represents the ICER analysis which shows that the infection control model for the financial year 2015–2016 was more cost-effective as compared to the ICM for the financial year 2014–2015.
Table 7: Incremental cost, incremental benefits and incremental cost-effectiveness ratio

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  Discussion Top


The HCAI increases the financial burden on a health-care sector. The increasing costs are demonstrated by a number of factors such as increased readmissions to the hospital, length of stay, use of antimicrobials, laboratory and radiological services, cost attributable to diagnosing and managing HCAI and surveillance and isolation measures for multidrug-resistant organisms.[4] A 10-year survey in the Netherlands demonstrated that adequate funding of ICP led to a reduction in HCAI which in turn resulted in epidemiological and financial benefits.[5]

Our study demonstrates that increased investments in ICP have a significant impact on reducing HCAI. This was in accordance with the Canadian study which demonstrated that after increased investments in ICP with a budget of $ 6.7 million over a period of 4 years led to a reduction of 4739 HCAI.[6]

A successful ICP requires an estimate of incremental budgeting for a new infection control strategy and the health benefits obtained from prevented number of HCAI.[7],[8] Of the various interventions to prevent HCAI, the best intervention is the one that minimises the cost per infection prevented.[9] ICER allows for direct comparison between two strategies for clinical and cost-effectiveness. This is beneficial for decision-making regarding the adoption of the new intervention.[2] Many studies have stressed on the need for a comprehensive infection control budget and evaluation of its cost-effectiveness.[10],[11] We evaluated the two successive years ICP using ICER for its cost–effectiveness, and it was demonstrated that the ICP of the financial year 2015–2016 was more cost-effective.


  Conclusion Top


The incremental budgeting for ICP had a significant impact on HCAI and also proved to be a cost-effective intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. The Burden of Health-Care Associated infection Worldwide. Geneva; World Health Organization; 20 April, 2010. Available from: http://www.who.int/gpsc/country work/summary-20100430_en.pdf. [Last accessed on 2016 Nov 28].  Back to cited text no. 1
    
2.
Stone PW. Economic burden of healthcare-associated infections: An American perspective. Expert Rev Pharmacoecon Outcomes Res 2009;9:417-22.  Back to cited text no. 2
    
3.
Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Cost-effectiveness analysis. In: Priorities in Health. Ch. 3. Washington (DC): The International Bank for Reconstruction and Development/the World Bank; 2006. https://www.ncbi.nlm.nih.gov/books/NBK10253/. [Last accessed on 2016 Dec 03].  Back to cited text no. 3
    
4.
Friedman C, Barnette M, Buck AS, Ham R, Harris JA, Hoffman P, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: A consensus panel report. Am J Infect Control 1999;27:418-30.  Back to cited text no. 4
    
5.
Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: Morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552-7.  Back to cited text no. 5
    
6.
Raschka S, Dempster L, Bryce E. Health economic evaluation of an infection prevention and control program: Are quality and patient safety programs worth the investment? Am J Infect Control 2013;41:773-7.  Back to cited text no. 6
    
7.
Vriens M, Blok H, Fluit A, Troelstra A, Van Der Werken C, Verhoef J. Costs associated with a strict policy to eradicate methicillin-resistant i in a Dutch University medical center: A 10-year survey. Eur J Clin Microbiol Infect Dis 2002;21:782-6.  Back to cited text no. 7
    
8.
Drummond MF, Schulpher MJ, Torrance GW, O'Brien BJ, Stoddort GL. Methods for Economic Evaluation of Health Care Programs. 3rd ed. Oxford, UK: Oxford University Press; 2005.  Back to cited text no. 8
    
9.
Graves N, McGowan JE Jr. Nosocomial infection, the deficit reduction act, and incentives for hospitals. JAMA 2008;300:1577-9.  Back to cited text no. 9
    
10.
Jayaraman SP, Jiang Y, Resch S, Askari R, Klompas M. Cost-effectiveness of a model infection control program for preventing multi-drug-resistant organism infections in critically ill surgical patients. Surg Infect (Larchmt) 2016;17:589-95.  Back to cited text no. 10
    
11.
Mehtar S. Infection control programmes-are they cost-effective. J Hosp Infect 1995;30:26-37.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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