Abstract
Whereas the cost burden of healthcare-associated infection (HAI) extends beyond the inpatient stay into the post-discharge period, few studies have focused on post-discharge costs. To investigate the impact of all types of HAI on the magnitude and distribution of post-discharge costs observed in acute and community services for patients who developed HAI during their inpatient stay. Using data from the Evaluation of Cost of Nosocomial Infection (ECONI) study and regression methods, this study identifies the marginal effect of HAI on the 90-daypost-discharge resource use and costs. To calculate monetary values, unit costs were applied to estimates of excess resource use per case of HAI. Post-discharge costs increase inpatient HAI costs by 36%, with an annual national cost of £10,832,437. The total extra cost per patient with HAI was £1,457 (95% confidence interval: 1,004-4,244) in the 90 days post discharge. Patients with HAI had longer LOS if they were readmitted and were prescribed more antibiotics in the community. The results suggest that HAI did not have an impact on the number of readmissions or repeat surgeries within 90 days of discharge. The majority (95%) of the excess costs was on acute care services after readmission. Bloodstream infection, gastrointestinal infection, and pneumonia had the biggest impact on post-discharge cost. HAI increases costs and antibiotic consumption in the post-discharge period. Economic evaluations of IPC studies should incorporate post-discharge costs. These findings can be used nationally and internationally to support decision-making on the impact of IPC interventions.
Highlights
Healthcare-associated infections (HAIs) increase the cost of healthcare and impose additional morbidity and risk of mortality [1]
The cost burden extends beyond the inpatient stay into the post-discharge period, yet a 2005 review showed that most published studies focus on inpatient costs only, additional length of stay (LOS), and ignore the postdischarge period [2]
The HAI group showed a greater proportion of comorbidities than the non-HAI group, had more recent inpatient procedures, and a greater number of days in hospital within the two years preceding their index admission
Summary
Healthcare-associated infections (HAIs) increase the cost of healthcare and impose additional morbidity and risk of mortality [1]. Previous research has mostly focused on the post-discharge incidence of surgical site infection (SSI) and associated costs [3e5]. Reporting post-discharge impact of HAI requires long-term follow-up of patients with, and without, HAI once they have left hospital. One review in the USA estimated that between 9% and 13% of the total health cost of HAI occurs post discharge and highlighted the wide range of methodologies, different HAI types, settings and differences in reporting [14]. These create challenges when interpreting the findings of the few studies that include a perspective broader than acute hospitals
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