Ryan P, Skally M, Duffy F, Farrelly M, Gaughan L, Flood P, McFadden E, Fitzpatrick F
Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
J Hosp Infect. 2017 Apr;95(4):415-420. doi: 10.1016/j.jhin.2017.01.016. Epub 2017 Feb 2.
Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished.
To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015.
A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure.
The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included).
As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making.
艰难梭菌感染（CDI）的经济分析应考虑机构决策者面临的激励因素。为避免高估感染预防的经济效益，应区分固定成本和可变成本。
量化2015年8月一家三级转诊医院的CDI固定成本和可变成本。
采用微观成本分析估算每位患者的CDI成本，包括CDI暴发的额外成本。在查阅患者病历、药房数据、行政资源投入以及工资和清洁/去污支出记录后，对资源使用情况进行了量化。
CDI的增量成本为75,680欧元（平均每位患者5,820欧元），主要成本驱动因素为清洁、药品和住院时间（LOS）。额外住院时间为1.75至22.55天。对于7例参与CDI暴发的患者，不包括58个床位损失日的价值（34,585欧元），成本高出30%（每位患者7,589欧元）。因此，CDI的总支出为88,062欧元（所有患者平均6,773欧元）。如果包括暴发成本，可变成本的潜在节省为1,026欧元（17%）或1,768欧元（26%）。投资一名抗菌药物药剂师每年需要预防47例CDI病例。预防5%、10%和20%的CDI可使可归因成本分别降低4,403欧元、8,806欧元和17,612欧元。将CDI导致的增量住院时间增加到每位患者7天，成本将增加到7,478欧元或8,431欧元（如果包括暴发成本）。
由于CDI成本大多是固定的，感染预防的潜在节省有限。未来的分析必须更有效地考虑这种区别及其对机构决策的影响。
