Financial Impact of Health Care‐associated Infections: When Money Talks

A ccording to the Canadian Institute for Health Information, health spending in Canada was projected to reach $211 billion in 2013 (versus $207 billion in 2012), corresponding to $5,988 per person (1).Overall, this represents 11.2% of Canada's gross domestic product.Approximately 60% of total health spending is directed to hospitals (30%), drugs (16%) and physicians (15%).Although it is difficult to estimate, the proportion of this spending attributed to the management of nosocomial infections, overuse and/or misuse of antimicrobials, and infections due to multidrug-resistant bacteria is significant.Despite the availability of efficient strategies targeting each of these aspects, large-scale progress has not been demonstrated.In a recent meta-analysis, Zimlichman et al (2) included 26 studies and used incidence estimates from the National Healthcare Safety Network of the Centers for Disease Control and Prevention, formerly known as the National Nosocomial Infections Surveillance (NNIS).They estimated the costs and excess length of stay (xLOS) associated with significant health care-associated infections (HAIs).On a per-case basis, central lineassociated bloodstream infections (CLABSIs) were found to be the most costly (US$45,814 [2012]; xLOS 10.4 days), followed by ventilatorassociated pneumonia (US$40,144; xLOS 13.1 days) and surgical site infections (US$20,785; xLOS 11.2 days).When caused by methicillinresistant Staphylococcus aureus (MRSA), both the cost and xLOS of surgical site infections increased by 105%; CLABSI cost increased by 22% and CLABSI xLOS increased by 51%.These results highlight the importance of strategies to control bacterial antibiotic resistance.The three most significant antibiotic-resistant bacteria found in Canadian centres are MRSA, vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase (ESBL)-producing organisms.A summary of a literature review is shown in Table 1.Most studies were from different states in the United States (US), and used retrospective cohorts from administrative databases and various analyses with various levels of sophistocation.Very few cost assessments were found for Canada: according to a systematic review (3), MRSA infection cost the Canadian health system between $54 million and $110 million (2005 CAD$) (direct attributable health care cost per year) including infection, colonization and infrastructure.The average cost per patient for MRSA infection was estimated to be $12,216 (range $6,878 to $17,553) (3).In a conference publication, Muller et al (4) showed that $10 million in expenses were needed to control an MRSA outbreak in Toronto (Ontario) in 2006 to 2007, increasing hospital cost per patient by 35%.In studies from the US, Filice et al (5) estimated adjusted mean cost of medical services for MRSA in patients with low Charlson's score (0 to 3) to be $51,252 (2007 US$) (95% CI $46,041 to $56,464) versus $30,158 (95% CI $27,092 to $33,225) for methicillin-sensitive Staphylococcus aureus, and up to $84,436 (95% CI $79,843 to $89,029) versus $59,245 (95% CI $56,016 to $62,473) for a high Charlson's score (≥4).Shorr et al (6) did not find significant differences between MRSA and methicillinsensitive Staphylococcus aureus in a crude analysis, but estimates of cost were both high ($70,028 versus $71,186).Only one study assessed the cost of VRE; performed in Vancouver, British Columbia (7), it involved a large sample (n=1292) and showed Financial impact of health care-associated infections:When money talks

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