Cost savings of a nationwide project preventing healthcare-associated infections in adult, paediatric and neonatal critical care settings in Brazil: a micro-costing study

Abstract

Objective: To provide evidence of the cost savings of a quality improvement (QI) initiative preventing healthcare-associated infections (HAIs) in critical care settings.

Design: A micro-costing study focused on financial data related to a nationwide multicentric project preventing central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).

Setting: Brazilian public healthcare system.

Participants: Adult, paediatric and neonatal intensive care units (ICUs) participating in the QI initiative.

Intervention: This collaborative QI project implemented a multifaceted strategy to enhance infection-control measures. Participating ICUs reported the number of patients with and without HAIs and information on each HAI's aggregate average cost (AC), which was analysed following the Brazilian Ministry of Health's micro-costing guidelines. The 1-year preintervention period evidenced an aggregated AC in adult, paediatric and neonatal ICUs, respectively, of Intl$21 763.5 (95% CI 20 683.6 to 22 843.0), Intl$34 062.4 (95% CI 25 819.6 to 42 304.9) and Intl$32 903.2 (95% CI 29 203.6 to 36 602.4) for CLABSI; Intl$25 202.5 (95% CI 24 276.6 to 26 127.8), Intl$44 753.6 and Intl$17 238.4 for VAP and Intl$19 166.3 (95% CI 17 676.2 to 20 656.1) and Intl$55 873.3 (95% CI 43 563.1 to 68 183.1) for CAUTI (not included neonatal ICUs).

Primary outcome: The cost savings were estimated using the HAIs prevented-expenses avoided-during the QI intervention period from September 2021 to December 2023. The HAIs prevented were estimated using the difference between observed and predicted infections based on the aggregated preintervention baseline.

Results: Of the 188 participating ICUs, 31 voluntarily completed and provided the requested financial data with 100% accuracy. Considering the prevented 7342 HAIs for adult, paediatric and neonatal ICUs, respectively: 1647, 86 and 205 CLABSI; 3775, 114 and 118 VAP; and 1377 and 20 CAUTI, we estimated a saving of Intl$175.3 million (95% CI 153.2 to 180.9 million) to the Brazilian unified health system and a resultant estimated return on investment (ROI) of 890%.

Conclusion: This QI collaborative is a value-based initiative preventing HAIs in adult, paediatric and neonatal ICUs in South American settings. The substantial cost savings and a remarkable ROI underscore the economic viability of investing in comprehensive QI infection prevention strategies.

Keywords: Health economics; Infection control; Intensive Care Units.

Figure 1. The 10 steps to obtain costs for each patient represent the data obtained in different areas during hospitalisation and the main costs generated. ICU, intensive care unit; HAI, healthcare-associated infection; ICD-10, International Classification of Diseases, 10th revision.

Figure 2. Overview of the clinical and financial indicators of the ‘Saúde em Nossas Mãos’ project. (A) Patients treated in intensive care units; (B) Cost of patients treated in intensive care units. ICUs, intensive care units; HAIs, healthcare-associated infections; BRL$, real (Brazilian currency); LOS, length of stay.

Figure 3. (A) Violin plot showing the aggregate average cost (BRL$) by intensive care unit type, with and without healthcare-associated infection. (B) Boxplot showing the aggregate average cost (BRL$) by intensive care unit type for each healthcare-associated infection analysed. AC, average cost; BRL$, real (Brazilian currency); HAI, healthcare-associated infection; ICU, intensive care unit; CLABSI, central line-associated bloodstream infection; VAP, ventilator-associated pneumonia; CAUTI, catheter-associated urinary tract infection.

Figure 4. Sensitivity analysis. Tornado diagram detailing the aggregate average cost (BRL$) by expense categories comparing patients without (A) and with (B) healthcare-associated infections. AC, average cost; BRL$, real (Brazilian currency); ICU, intensive care unit.

Figure 5. (A) 3D plot showing the distribution of aggregated average cost by healthcare-associated infection and the mean length of stay. (B) Overall correlation between aggregated average cost and the mean length of stay. AC, average cost; BRL$, real (Brazilian currency); HAI, healthcare-associated infection; CLABSI, central line-associated bloodstream infection; VAP, ventilator-associated pneumonia; CAUTI, catheter-associated urinary tract infection; LOS, length of stay.