Financial Impact of Health Care‐associated Infections: When Money Talks
Bibliographic record
Abstract
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
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.039 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.011 | 0.009 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.005 | 0.008 |
| Insufficient payload (model declined to judge) | 0.017 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".