Measuring the Direct Medical Costs of Hospital-Onset Infections Using an Analogy Costing Framework

Abstract

Background: The majority of recent estimates on the direct medical cost attributable to hospital-onset infections (HOIs) has focused on device- or procedure-associated HOIs. The attributable costs of HOIs that are not associated with device use or procedures have not been extensively studied.

Objective: We developed simulation models of attributable cost for 16 HOIs and estimated the total direct medical cost, including nondevice-related HOIs in the USA for 2011 and 2015.

Data and methods: We used total discharge costs associated with HOI-related hospitalization from the National Inpatient Sample and applied an analogy costing methodology to develop simulation models of the costs attributable to HOIs. The mean attributable cost estimate from the simulation analysis was then multiplied by previously published estimates of the number of HOIs for 2011 and 2015 to generate national estimates of direct medical costs.

Results: After adjusting all estimates to 2017 US dollars, attributable cost estimates for select nondevice-related infections attributable cost estimates ranged from $7661 for ear, eye, nose, throat, and mouth (EENTM) infections to $27,709 for cardiovascular system infections in 2011; and from $8394 for EENTM to $26,445 for central nervous system infections in 2016 (based on 2015 incidence data). The national direct medical costs for all HOIs were $14.6 billion in 2011 and $12.1 billion in 2016. Nondevice- and nonprocedure-associated HOIs comprise approximately 26-28% of total HOI costs.

Conclusion: Results suggest that nondevice- and nonprocedure-related HOIs result in considerable costs to the healthcare system.

Fig. 1

Attributable HAI simulation cost model for lower respiratory tract infections. LRTI lower respiratory tract infection, LOS length of stay, HOI hospital-onset infection, ndx number of diagnosis, npr number of procedures, urban_teach urban teaching hospital, small_bedsize small bed size hospital, APRDRG_Severity All Patient Refined Diagnosis Related Groups Severity of Illness Subclass, APRDRG_Risk_Mortality All Patient Refined Diagnosis Related Groups Risk of Mortality Subclass, Wage_Index Centers for Medicare and Medicaid Services Wage Index, C_1,LRTI estimated cost parameter associated with LOS, C_2,LRTI estimated cost parameter associated with ndx, C_3,LRTI estimated cost parameter associated with npr, C_4,LRTI estimated cost parameter associated with urban_teach, C_5,LRTI estimated cost parameter associated with small_bedsize, C_6,LRTI estimated cost parameter associated with age, C_7,LRTI estimated cost parameter associated with APRDRG_Severity, C_8,LRTI estimated cost parameter associated with APRDRG_RISK_MORTALITY, C_9,LRTI estimated cost parameter associated with Wage_Index