Cost of infectious diseases.

Abstract

Physicians need to be concerned about their patients, not about the amount of money it takes to treat these patients. This frequently heard statement is true, but only to some degree – and may be less so today than a quarter century ago. It is still true that the medical needs of the patients are and should be our main concern. However, economic aspects of health care have become increasingly important in all fields of medicine and in all parts of the world. It is therefore not a coincidence that the first article in this issue analyzes cost of illness aspects of nosocomial pneumonia [1]. The authors performed a matched-pairs analysis to compare the cost of care for patients who developed nosocomial pneumonia with those patients who did not develop this complication. The finding that patients with pneumonia generated higher costs for their treatment than patients without pneumonia is not surprising. The fact that reimbursement of the hospital for these additional costs did not cover the whole amount is a strong argument for enhanced preventive efforts regarding this infection. Medical treatment is particularly costly in intensive care units. The prevalence of nosocomial infections is high in these units [2, 3]. Optimal diagnosis and treatment of infections in severely ill patients may benefit from the involvement of infectious diseases specialists. However, the presence of these specialists does not necessarily result in cost savings [4], but it may improve the quality of care of patients with infections [5]. Improved quality as a result of improved diagnosis and selection of appropriate antimicrobial agents may result in cost savings as a result of the early institution of effective treatment or through treatment modifications such as switching from parenteral to oral drug application [6]. Medical progress in the field of molekular diagnosis of infectious diseases provides new options to diagnose such infections either more quickly or more easily.The indiscriminate use of these new diagnostic tools may, however, have a negative impact on the overall cost of diagnosis and treatment of infections [7]. Studies on the cost-effectiveness of various diagnostic and therapeutic strategies for infections in the inpatient or outpatient setting need to be performed in order to establish the most appropriate use of such new diagnostic or therapeutic tools. Such studies have been performed to assess the treatment cost of patients with HIV infections [8, 9]. Even though such analyses are complex and must be performed using appropriate methods [10], the studies are needed in order to make evidence based decisions, which take into account medical as well as economic aspects of the management of infectious diseases. In addition, cost-of-illness analysis may be useful to guide health-care policy regarding public health issues such as the question whether a needle-exchange program is effective in reducing the risk for the transmission of hepatitis C [11]. Furthermore, costof-illness analysis may yield interesting information to better quantify needs for resources in third world countries [12]. In summary, aspects of health-care economics, especially cost-of-illness analysis provide additional and important information regarding the management of infectious diseases, which may help to put findings on the clinical effectiveness of interventions into perspective. Medical progress will increasingly also be assessed in such studies.