Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

Abstract

Objectives: To estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England.

Design: A modelling study based on a combination of published data and clinical practice.

Setting: NHS hospitals in England.

Primary and secondary outcome measures: Annual number of HCAIs, additional NHS cost, number of occupied hospital bed days and number of days front-line healthcare professionals (HCPs) are absent from work.

Results: In 2016/2017, there were an estimated 653 000 HCAIs among the 13.8 million adult inpatients in NHS general and teaching hospitals in England, of which 22 800 patients died as a result of their infection. Additionally, there were an estimated 13 900 HCAIs among 810 000 front-line HCPs in the year. These infections were estimated to account for a total of 5.6 million occupied hospital bed days and 62 500 days of absenteeism among front-line HCPs. In 2016/2017, HCAIs were estimated to have cost the NHS an estimated £2.1 billion, of which 99.8% was attributable to patient management and 0.2% was the additional cost of replacing absent front-line HCPs with bank or agency staff for a period of time. When the framework of the model was expanded to include all NHS hospitals in England (by adding specialist hospitals), there were an estimated 834 000 HCAIs in 2016/2017 costing the NHS £2.7 billion, and accounting for 28 500 patient deaths, 7.1 million occupied hospital bed days (equivalent to 21% of the annual number of all bed days across all NHS hospitals in England) and 79 700 days of absenteeism among front-line HCPs.

Conclusion: This study should provide updated estimates with which to inform policy and budgetary decisions pertaining to preventing and managing these infections. Clinical and economic benefits could accrue from an increased awareness of the impact that HCAIs impose on patients, the NHS and society as a whole.

Keywords: England; HCAIs; NHS; costs; healthcare associated infections; nosocomial infection.

Figure 1

Cost of illness algorithm depicting the movement of adult inpatients and front-line HCPs entering and leaving the open cohort of those who acquire a HCAI in an average year. HCAI, healthcare-associated infection; HCP, healthcare professional.

Figure 2

Distribution of costs and patient deaths and days of absences among front-line HCPs. HCAI, healthcare-associated infection; HCP, healthcare professional; NHS, National Health Service.

Figure 3

Distribution of costs and patient deaths, days of absences among front-line HCPs and number of HCAIs. HCAI, healthcare-associated infection; HCP, healthcare professional; NHS, National Health Service.

Figure 4

Distribution of costs and patient deaths, days of absences among front-line HCPs, number of HCAIs and occupied bed days attributable to HCAIs. HCAI, healthcare-associated infection; HCP, healthcare professional; NHS, National Health Service.