Outbreaks spike huge costs, but studies lack rigor
For the infection control professional, preventing both the exorbitantly expensive outbreak and the day-to-day endemic infection are two sides of the same health care coin. Though it is clear that prevention saves both lives and dollars, the ongoing efforts to quantify cost savings through infection control lack standardization and rigor, according to an economic analyst.
"We need to have good studies on both sides," says Patricia Stone, RN, PhD, assistant professor at Columbia University School of Nursing in New York City. "What is the cost of an infection when it happens in normal, everyday life and what can we do to prevent them? Then also, what is the cost of an outbreak? They are two sides of the same coin."
Stone looked at both sides, breaking down the costs of a $341,000 outbreak at her institution and also conducting an economic analysis of the infection control literature. It was in the larger picture where things got a little murky, due in part to a variety of methods used and lack of comparison groups.1 "Although there are standard guidelines on how to conduct a rigorous economic evaluation, often they are more back-of-the-envelope calculations," she says.
"When you look at the body of evidence and put it together — although you can get a certain sense of it — people can honestly critique the conclusions because the rigor is not there," she adds. "It is not in infection control only, it is in all health care. There hasn’t been enough rigor in these sorts of evaluations."
Stone recommends that ICPs consult the guidelines developed by the U.S. panel on Cost Effective-ness in Healthcare and Medicine in 1996.2 While the current methodology is fraught with variables, the high cost of nosocomial infections is underscored in the mean averages complied by Stone and colleagues. "The costs were quite impressive," she says. "We didn’t cost it out, but if you looked at the cost of a prevention program, most likely it would be much less than the costs of the infections. That certainly is the next way to go [in future research]."
The costs of an outbreak are, of course, considerably more than an infection here and there. The aforementioned $341,000 bill was the result of an outbreak of an extended spectrum a-lactamase Klebsiella pneumoniae in a neonatal intensive care unit at her hospital, Stone explains.
While not an infection control practitioner per se, Stone wanted to apply her economic background to do a thorough analysis of the cost of the outbreak. "It’s a simple cost analysis, but the cost of this outbreak is very impressive," she says. Data analyzed included an administrative database that uses National Perinatal Information Center data stratifying infants by birth weight and severity of illness; the cost-accounting department; departmental manager questionnaires; minutes from meetings; and published sources.
The four-month outbreak included eight infected and 14 colonized neonates. The attributable increased length of stay for infected neonates was on average 48 days at a cost of $590 per day. Interventions aimed at controlling the outbreak cost another $50,000. Revenues lost by the hospital due to blocked beds and closing the unit were estimated to be $161,000, Stone found. (See breakdown, below.)
|Direct patient care||$146,331|
|Surveillance & administration||66,794|
|Source: Columbia University, School of Nursing, New York City.|
A better understanding of the economic consequences of endemic infections and outbreaks may eventually translate to cost-effective interventions that prove the power of infection control prevention.
1. Stone PW, Larson E, Kawar LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control 2002; 30:145-152.
2. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in Health and Medicine. New York City: Oxford University Press; 1996.