Reducing Time-dependent Bias in Estimates of the Attributable Cost of Health Care–associated Methicillin-resistant Staphylococcus aureus Infections

A Comparison of Three Estimation Strategies

Dados Bibliográficos

ID9100711
AutoresRichard E Nelson (0000-0002-4441-7460, VA Salt Lake City Healthcare System, autor correspondente), Matthew H Samore (0000-0002-4862-9196, VA Salt Lake City Healthcare System, autor correspondente), Makoto Jones (0000-0001-5580-6739, University of Utah, autor correspondente), Tom Greene (0000-0002-3706-7570, University of Utah), Vanessa W Stevens, Vanessa Stevens (0000-0001-8933-5453, VA Salt Lake City Healthcare System, autor correspondente), Chuan-Fen Liu, Chuan‐Fen Liu (0000-0002-6915-8194, University of Washington), Nicholas Graves (0000-0002-5559-3267), Martin Evans (0000-0003-3597-6487, VA Salt Lake City Healthcare System, autor correspondente), Martin F Evans, Michael A Rubin (0000-0002-5623-4397), Michael Rubin (0000-0002-3177-133X, University of Utah, autor correspondente)
Ano2015
Volume53
Fascículo9
Páginas827-834
Data de publicação2015-09-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Care (JOURNAL)
Identificadores do periódicoISSN: 0025-7079 • E-ISSN: 1537-1948
EditoraOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000403
PMID26225444
OpenAlexW1843205630
IdiomaEN
Citações recebidas2
Referências citadas25

BACKGROUND: Previous estimates of the excess costs due to health care-associated infection (HAI) have scarcely addressed the issue of time-dependent bias. OBJECTIVE: We examined time-dependent bias by estimating the health care costs attributable to an HAI due to methicillin-resistant Staphylococcus aureus (MRSA) using a unique dataset in the Department of Veterans Affairs (VA) that makes it possible to distinguish between costs that occurred before and after an HAI. In addition, we compare our results to those from 2 other estimation strategies. METHODS: Using a historical cohort study design to estimate the excess predischarge costs attributable to MRSA HAIs, we conducted 3 analyses: (1) conventional, in which costs for the entire inpatient stay were compared between patients with and without MRSA HAIs; (2) post-HAI, which included only costs that occurred after an infection; and (3) matched, in which costs for the entire inpatient stay were compared between patients with an MRSA HAI and subset of patients without an MRSA HAI who were matched based on the time to infection. RESULTS: In our post-HAI analysis, estimates of the increase in inpatient costs due to MRSA HAI were $12,559 (P<0.0001) and $24,015 (P<0.0001) for variable and total costs, respectively. The excess variable and total cost estimates were 33.7% and 31.5% higher, respectively, when using the conventional methods and 14.6% and 11.8% higher, respectively, when using matched methods. CONCLUSIONS: This is the first study to account for time-dependent bias in the estimation of incremental per-patient health care costs attributable to HAI using a unique dataset in the VA. We found that failure to account for this bias can lead to overestimation of these costs. Matching on the timing of infection can reduce this bias substantially

Cohort study · Cost estimate · Estimation · Health care · Methicillin-resistant Staphylococcus aureus · Staphylococcus aureus · Veterans Affairs · Antibiotic Use and Resistance · Antimicrobial Resistance in Staphylococcus · Clostridium difficile and Clostridium perfringens research · Emergency Medicine · Internal Medicine · Medicine