When considering an infection prevention intervention, how should the costs calculated? The first question should be what costs should be calculated? With the myriad of direct, indirect, and intangiable costs related to HAIs, where is a facility to start? There are several types of costs to be taken into consideration, and each type will come from different sources. In this post, we will explore how a facility may collect cost data when evaluating a potential new infection intervention.
Costs of the Problem
First, let's consider attributable costs. These are the costs that are directly connected to and/or caused by the problem at hand; in this case, the problem is HAIs. While the definition of an HAI is determined by CMS and the CDC, attributable costs for infections should be calculated using facility-specific data. Hospitals or other healthcare facilities can identify cases of hospital-acquired infections using the federal definition and determine the cost for each case, including added length of stay, additional medications needed to treat the HAI, procedures performed to eliminate the HAI, and staff time required for both prevention and treatment. In the most recent study of the impact of HAIs on the US Health Care System, it was estimated that the five most common infections cost the US $9.8 billion, with an estimate for per-case costs. Using this data as well as the data from your own facility, you will begin to get a better picture of the exact burden of cost on your facility.
|Most recent per-case costs of the five most prevalent HAIs1|
|CLABSI||$30,919 - $65,245|
|VAP||$36,286 - $44,220|
|SSI*||$18,785 - $22,667|
|C. difficile||$9,118 - $13,574|
|CAUTI||$603 - $1,189|
1 Zimlichman E JAMA 2013:173(22) * SSIs account for the highest percentage of total costs of HAIs at 33.7%
Second, there are also indirect costs related to HAIs. These could include lost opportunity for accepting new patients, the loss of payments from private insurers, and even the loss of reputation due to published lower infection rates. This could be compounded by the possibility of medial malpractice cases and hospital liability issues related to outbreaks.
Finally, how about those intangible societal costs that we mentioned in the last post? The patient who loses work due to complications from a routine procedure? The ongoing pain and fear that follows a patient with a C. difficile infection for decades? There are established ways to help give a dollar amount to societal impacts such as quality of life, loss of a limb, or even loss of a life. These costs help the facility quantify costs that are most dear to their patients, putting them into a number form that can become a component of a complete cost-effectiveness analysis.
Costs of the Solution
When considering the costs associated with the intervention, a complete picture of immediate and future costs is critical. The cost of the intervention itself will come from the supplier, but additional related costs may have to be requested. There is the initial cost of the intervention, but then there may be upkeep costs, continued training needs, or technology upgrades. For example, a hand-washing intervention may require the initial training and implementation, but may also require ongoing education, infrastructure costs such as installing more cleaning products, or data collection and analysis. On the other hand, some interventions require no additional human processes, including training, or special supplies for upkeep. These interventions could result in a higher cost-effectiveness over the long term.
As anyone who attempts to conduct a cost-effectiveness study on an intervention will soon discover, there are complex factors to consider. Perhaps the most important factor, however, is how effective is the intervention in the first place? How do we know that the intervention will provide the results we expect, both for the patient and for our bottom line? We will answer these questions in our final post in this series. Stay tuned!