Dick Andrew W, Perencevich Eli N, Pogorzelska-Maziarz Monika, Zwanziger Jack, Larson Elaine L, Stone Patricia W
RAND Corporation, Pittsburgh, PA.
Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine University of Iowa, Carver College of Medicine and Iowa City VA Medical Center, Iowa City, IA.
Am J Infect Control. 2015 Jan;43(1):4-9. doi: 10.1016/j.ajic.2014.07.014.
Health care-associated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs).
Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central line-associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled.
Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were $174,713.09 for CLABSI and $163,090.54 for VAP. The ICERs were $14,250.74 per LY gained and $23,277.86 per QALY gained.
Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.
随着多方面感染预防项目的开展，医疗保健相关感染（HAI）率有所下降。然而，这些项目需要持续投入。我们的目标是研究医院在重症监护病房（ICU）持续投入预防HAI的成本效益。
将五年的医疗保险数据与从文献中获取的HAI率、成本及生活质量估计值相结合。对有和没有中心静脉导管相关血流感染（CLABSI）和/或呼吸机相关性肺炎（VAP）情况下的生命年（LYs）、质量调整生命年（QALYs）、医疗保健支出，以及多方面HAI预防项目的增量成本效益比（ICERs）进行建模。
由于感染预防项目，每个ICU获得的总LYs和QALYs，对于CLABSI分别为15.55 LY和9.61 QALY，对于VAP分别为10.84 LY和6.55 QALY。索引住院ICU成本的降低，对于CLABSI为174,713.09美元，对于VAP为163,090.54美元。ICERs分别为每获得1 LY 14,250.74美元和每获得1 QALY 23,277.86美元。
多方面HAI预防项目具有成本效益。我们的结果强调了持续投入预防HAI的重要性。如果暂停投入，有利的ICERs所隐含的福利效益将会丧失。
