Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA.
Med Care. 2010 Nov;48(11):1026-35. doi: 10.1097/MLR.0b013e3181ef60a2.
Hospitals will increasingly bear the costs for healthcare-acquired conditions such as infection. Our goals were to estimate the costs attributable to healthcare-acquired infection (HAI) and conduct a sensitivity analysis comparing analytic methods.
A random sample of high-risk adults hospitalized in the year 2000 was selected. Measurements included total and variable medical costs, length of stay (LOS), HAI site, APACHE III score, antimicrobial resistance, and mortality. Medical costs were measured from the hospital perspective. Analytic methods included ordinary least squares linear regression and median quantile regression, Winsorizing, propensity score case matching, attributable LOS multiplied by mean daily cost, semi-log transformation, and generalized linear modeling. Three-state proportional hazards modeling was also used for LOS estimation. Attributable mortality was estimated using logistic regression.
Among 1253 patients, 159 (12.7%) developed HAI. Using different methods, attributable total costs ranged between $9310 to $21,013, variable costs were $1581 to $6824, LOS was 5.9 to 9.6 days, and attributable mortality was 6.1%. The semi-log transformation regression indicated that HAI doubles hospital cost. The totals for 159 patients were $1.48 to $3.34 million in medical cost and $5.27 million for premature death. Excess LOS totaled 844 to 1373 hospital days.
Costs for HAI were considerable from hospital and societal perspectives. This suggests that HAI prevention expenditures would be balanced by savings in medical costs, lives saved and available hospital days that could be used by overcrowded hospitals to enhance available services. Our results obtained by applying different economic methods to a single detailed dataset may inform future cost analyses.
医院将越来越多地承担医疗保健获得性疾病（如感染）的费用。我们的目标是估计医疗保健获得性感染（HAI）的成本，并比较分析方法进行敏感性分析。
选择 2000 年住院的高危成年人进行随机抽样。测量包括总医疗费用和可变医疗费用、住院时间（LOS）、HAI 部位、APACHE III 评分、抗菌药物耐药性和死亡率。医疗费用从医院角度进行测量。分析方法包括普通最小二乘线性回归和中位数分位数回归、Winsor 化、倾向评分病例匹配、归因 LOS 乘以平均每日费用、半对数变换和广义线性建模。还使用三状态比例风险模型进行 LOS 估计。归因死亡率使用逻辑回归进行估计。
在 1253 名患者中，有 159 名（12.7%）发生了 HAI。使用不同的方法，归因总成本在$9310 到$21013 之间，可变成本在$1581 到$6824 之间，LOS 在 5.9 到 9.6 天之间，归因死亡率在 6.1%。半对数变换回归表明，HAI 使医院成本增加一倍。159 名患者的总医疗费用为$1.48 到$3.34 百万，过早死亡费用为$5.27 百万。超额 LOS 总计 844 到 1373 个医院日。
从医院和社会的角度来看，HAI 的成本相当可观。这表明，HAI 预防支出将通过医疗成本的节省、挽救的生命和可用的医院日得到平衡，这些可用的医院日可以被过度拥挤的医院用来增加可用服务。我们通过对单个详细数据集应用不同的经济方法获得的结果可以为未来的成本分析提供信息。
