Assessing the social cost and benefits of a national requirement establishing antibiotic stewardship programs to prevent Clostridioides difficile infection in US hospitals

R Douglas Scott,Fernanda C Lessa,Rachel B Slayton,L Clifford Mcdonald,Steven D Culler,James Baggs,John A Jernigan

doi:10.1186/s13756-018-0459-1

Abstract

BackgoundEconomic evaluations of interventions to prevent healthcare-associated infections in the United States rarely take the societal perspective and thus ignore the potential benefits of morbidity and mortality risk reductions. Using new Department of Health and Human Services guidelines for regulatory impact analysis, we developed a cost-benefit analyses of a national multifaceted, in-hospital Clostridioides difficile infection prevention program (including staffing an antibiotic stewardship program) that incorporated value of statistical life estimates to obtain economic values associated with morbidity and mortality risk reductions.MethodsWe used a net present value model to assess costs and benefits associated with antibiotic stewardship programs. Model inputs included treatment costs, intervention costs, healthcare-associated Clostridioides difficile infection cases, attributable deaths, and the value of statistical life which was used to estimate the economic value of morbidity and mortality risk reductions.ResultsFrom 2015 to 2020, total net benefits of the intervention to the healthcare system range from $300 million to $7.6 billion when values for morbidity and mortality risk reductions are ignored. Including these values, the net social benefits of the intervention range from $21 billion to $624 billion with the annualized net benefit of $25.5 billion under our most likely outcome scenario.ConclusionsIncorporating the economic value of morbidity and mortality risk reductions in economic evaluations of healthcare-associated infections will significantly increase the benefits resulting from prevention.

Highlights

Healthcare-associated Infections (HAIs) pose a serious health threat to hospitalized patients with an estimated 4% of hospitalized patients in the United States (US) infected at any given time [1]
Using the cost perspective of the federal government, the national financial savings to the Medicare program was estimated to be $2.5 billion (2011 dollars) with a credible range of $1.2 billion to $4.0 billion over the five year study period. To expand this analysis from a Medicare cost perspective to reflect a societal cost perspective, we developed national estimates of the benefits of averted cases and reduced mortality risk for all ages using results from Lessa et al which derived population-based estimates of the incidence and disease burden for (1) health care-associated Clostridioides difficile (HCA-Clostridioides difficile infection (CDI)) (2) recurrent HCA-CDI cases stemming from these infections, and (3) the number of deaths occurring within 30 days after the diagnosis of HCA-CDI [28]
Using the low estimates of program effectiveness and attributable mortality (10 and 35% respectively), the model projects that 203,591 total inpatient cases and 5625 deaths were averted at the 7% discount rate, and 224,304 total inpatient cases and 6199 deaths were averted at the 3% discount rate

Summary

Introduction

Healthcare-associated Infections (HAIs) pose a serious health threat to hospitalized patients with an estimated 4% of hospitalized patients in the United States (US) infected at any given time [1]. To mitigate this threat, actions are being taken by a myriad of public health organizations including government agencies, professional associations, private industry, and consumer groups. Actions are being taken by a myriad of public health organizations including government agencies, professional associations, private industry, and consumer groups These actions include mandatory public reporting of hospital HAI rates and the formation of prevention collaboratives composed of multiple hospitals working together to prevent HAIs [2]. While this work is still important, relying on analyses based on the provider cost perspective ignores the cost impacts to patients (travel costs, lost wages, long term morbidities, insurance co-pays), third party payers (increased per-patient reimbursements), and to society (mortality)

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