Measuring the Financial Burden of Resistance: What Should Be Compared?

Kaier, Klaus; Mutters, Nico T.; Wolkewitz, Martin

doi:10.1093/cid/ciz096

Cited by 3 publications

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“…This approach means that different types of infections (MDR or non-MDR Pseudomonas aeruginosa ) were compared to uninfected controls. Previous studies often directly compared MDR and non-MDR cases [35], which implies the assumption of the so-called “replacement scenario”: It assumes that every infection caused by resistant bacteria would be replaced by an infection caused by more susceptible bacteria if the spread of resistant pathogens was prevented [36–38]. Yet antibiotic resistance does not only increase the burden of infections: It is also responsible for the onset of infection through the failure of antibiotic prophylaxis [39].…”

Section: Methodsmentioning

confidence: 99%

Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

et al. 2019

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BackgroundPseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease.MethodsTwo hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders.ResultsPseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases.ConclusionsPseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.

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Section: Methodsmentioning

confidence: 99%

Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

et al. 2019

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Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression

et al. 2019

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The impact of mechanical ventilation on the daily costs of intensive care unit (ICU) care is largely unknown. We thus conducted a systematic search for studies measuring the daily costs of ICU stays for general populations of adults (age ≥18 years) and the added costs of mechanical ventilation. The relative increase in the daily costs was estimated using random effects meta regression. The results of the analyses were applied to a recent study calculating the excess length-of-stay associated with ICU-acquired (ventilator-associated) pneumonia, a major complication of mechanical ventilation. The search identified five eligible studies including a total of 54 766 patients and ~238 037 patient days in the ICU. Overall, mechanical ventilation was associated with a 25.8% (95% CI 4.7%–51.2%) increase in the daily costs of ICU care. A combination of these estimates with standardised unit costs results in approximate daily costs of a single ventilated ICU day of €1654 and €1580 in France and Germany, respectively. Mechanical ventilation is a major driver of ICU costs and should be taken into account when measuring the financial burden of adverse events in ICU settings.

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Reply to Kaier, Mutters, and Wolkewitz

Huang

Zong

2019

Clinical Infectious Diseases

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Measuring the Financial Burden of Resistance: What Should Be Compared?

Cited by 3 publications

References 6 publications

Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

Measuring the in-hospital costs of Pseudomonas aeruginosa pneumonia: methodology and results from a German teaching hospital

Impact of mechanical ventilation on the daily costs of ICU care: a systematic review and meta regression

Reply to Kaier, Mutters, and Wolkewitz

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