تحلیل هزینه فایده از جلوگیری از عفونتهای بیمارستانی در بین بیماران همودیالیزی در کانادا در سال 2004

Objectives Hemodialysis-associated bloodstream infection (BSI) is a significant public health problem because the number of hemodialysis patients in Canada had doubled from 1996 to 2005. Our study aimed to determine the costs of nosocomial BSIs in Canada and estimate the investment expenses for establishing infection control programs in general hospitals and conduct cost–benefit analysis. Materials and Methods The data from the Canadian Nosocomial Infection Surveillance Program was used to estimate the incidence rate of nosocomial BSI. We used Canadian Institute of Health Information data to estimate the extra costs of BSIs per stay across Canada in 2004. The cost of establishing and maintaining an infection control program in 1985 was estimated by the US Centers for Disease Control and Prevention and converted into 2004 Canadian costs. The possible 20% to 30% reduction of total nosocomial BSIs was hypothesized. Results A total of 2524 hemodialysis-associated BSIs were projected among 15,278 hemodialysis patients in Canada in 2004. The total annual costs to treat BSIs were estimated to be CDN$49.01 million. Total investment costs in prevention and human resources were CDN$8.15 million. The savings of avoidable medical costs after establishing infection control programs were CDN$14.52 million. The benefit/cost ratio was 1.0 to 1.8:1. Conclusion Our study provides evidence that the economic benefit from implementing infection control programs could be expected to be well in excess of additional cost postinfection if the reduction of BSI can be reduced by 20% to 30%. Infection control offered double benefits: saving money while simultaneously improving the quality of care.

Infections acquired during the use of health-care services are significant public health problems both for the health-care delivery system and the patient. It has been reported that an estimated 220,000 nosocomial infections are acquired in health-care facilities and 8000 deaths attributable to these infections occur annually in Canada [1]. The most common nosocomial infections are surgical wounds, blood stream, and urinary tract infections [2,3]. Taylor et al. reported that the relative risk for bloodstream infection (BSI) was 2.5 with arteriovenous graft access, 15.5 with cuffed and tunnelled central venous catheter (CVC) access, and 22.5 with uncuffed CVC access [4]. Nosocomial BSIs result in dramatic increases in economic cost. In the United States in 2000, approximately 240,000 dialysis patients were treated at 3700 outpatient facilities [5]. The length of hospital stay was extended by 1 to 4 weeks at a cost of up to $40,000 (US dollars) per survivor [6–9]. The US Centers for Disease Control and Prevention (US CDC)estimated that the excess costs associated with nosocomial infections in US hospitals were $4.5 billion in 1992 [10]. In Canada, there are no detailed reports on excess costs associated with nosocomial infections, including BSIs. The purpose of this study was to determine the cost of nosocomial BSIs among hemodialysis patients in Canada in 2004. We also estimated the cost of an infection control program a middlesized hospital in Canada in 2004 with the assumption that the outpatient hemodialysis centre is run out of the hospital. Finally, we conducted cost–benefit analyses of establishing and running hospital-based infection control programs in Canada.

Health-care practice has evolved during the last two decades. Our cost–benefit analysis demonstrated that there is a good benefit–cost ratio when the infection control program can prevent 20% to 30% of nosocomial BSIs cases. Infection control offers dual benefits: it saves money while simultaneously improving the quality of care. Effective infection control programs generate monetary benefits by preventing nosocomial infections and increasing health care efficiency by reducing additional burden. From the standpoint of both the hospital and of the community, the benefits justify the costs. The economic future of infection control depends on its ability to continue to demonstrate that it is both effective and cost effective.