中心静脉相关血流感染的医院成本和密闭式与开放式输液容器的成本效益。以意大利重症监护病房为例。
Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy.
机构信息
CERGAS-Bocconi University, Via Roentgen 1, 21036 Milan, Italy.
出版信息
Cost Eff Resour Alloc. 2010 May 10;8:8. doi: 10.1186/1478-7547-8-8.
OBJECTIVES
The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers.
METHODS
A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers.
RESULTS
A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were euro 18,241 and euro 9,087, respectively (p < 0.001). On average, the extra cost for drugs was euro 843 (p < 0.001), for supplies euro 133 (p = 0.116), for lab tests euro 171 (p < 0.001), and for specialist visits euro 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was euro 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management.
CONCLUSIONS
CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.
目的
评估中心静脉导管相关性血流感染（CLABSI）的直接医疗成本，并计算密闭式完全可折叠塑料静脉输液容器与开放式（玻璃）输液容器的成本效益比。
方法
在意大利一所教学医院的 4 个重症监护病房进行了为期两年的前瞻性病例对照研究。将 CLABSI 患者（病例）与无 CLABSI 患者（对照）按入院科室、性别、年龄和平均疾病严重程度评分进行匹配。根据微观成本法估算成本。在成本效果分析中，成本部分评估为两种输液容器相关的生产成本差异，而效果则通过 CLABSI 发生率（每 1000 个中心静脉置管天数的 CLABSI 例数）来衡量。
结果
共比较了 43 例 CLABSI 病例和 97 例匹配对照。病例和对照的平均年龄分别为 62.1 岁和 66.6 岁（p=0.143）；56%的病例和 57%的对照为女性（p=0.922）。病例和对照的平均住院时间分别为 17.41 天和 8.55 天（p＜0.001）。总体而言，CLABSI 患者和无 CLABSI 患者的平均总费用分别为 18241 欧元和 9087 欧元（p＜0.001）。平均而言，药物的额外费用为 843 欧元（p＜0.001），用品为 133 欧元（p=0.116），实验室检查为 171 欧元（p＜0.001），专家就诊为 15 欧元（p=0.019）。住院费用（间接费用）的额外费用平均为 7180 欧元（p＜0.001）。密闭式输液容器是一种主导策略。它导致较低的 CLABSI 发生率（密闭式与开放式输液容器的每 1000 个中心静脉置管天数的 CLABSI 分别为 3.5 例和 8.2 例），而总生产成本没有显著差异。密闭式输液容器较高的购置成本被生产其他阶段的节约所抵消，特别是废物管理方面的节约。
结论
CLABSI 导致医院资源的大量显著增加。使用封闭式输液容器等创新技术可以显著降低医疗保健相关感染的发生率，而不会给医院预算带来额外负担。
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