Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital

Excess length of stay and costs

M. Macedo-Viñas, Giulia De Angelis, Peter Rohner, Edith Safran, A. Stewardson, Carolina Fankhauser, Jacques Schrenzel, Didier Pittet, Stephan Harbarth

Research output: Contribution to journalArticleResearchpeer-review

35 Citations (Scopus)

Abstract

Background: Meticillin-resistant Staphylococcus aureus (MRSA) infections increase hospital costs primarily by prolonging patient length of stay (LOS). Aim: To estimate the health-economic burden of MRSA infections at a Swiss University hospital using different analytical approaches. Methods: Excess LOS was estimated by: (i) multistate modelling comparing MRSA-infected and MRSA-free patients with MRSA infection as time-dependent exposure; (ii) matching MRSA-infected patients with a cohort of MRSA-uninfected patients. The economic impact was assessed by: (i) comparing cost estimates between MRSA-infected and MRSA-free patients and multiplying excess LOS by bed-day cost; (ii) comparing real costs between MRSA-infected and MRSA-colonized non-infected patients. Findings: The crude mean LOS was 37.3, 33.0 and 8.8 days for MRSA-infected, MRSA-colonized and MRSA-free patients, respectively. Excess LOS attributable to MRSA infection was 11.5 [95% confidence interval (CI): 7.9-15] or 15.3 days according to multistate modelling and matched analysis, respectively. The likelihood of discharge after MRSA infection was significantly reduced (adjusted hazard ratio: 0.69; 95% CI: 0.59-0.81). Average bed-day costs for MRSA-infected patients were 1.49- and 1.26-fold higher than for the general population hospitalized in acute wards and MRSA-colonized patients, respectively. MRSA infection resulted in an average additional cost of about 800 Swiss francs per day. Conclusions: This analysis emphasizes the financial impact of MRSA infections, demonstrates the importance of accounting for time-dependent bias and confirms that multistate modelling is a valid strategy for estimating excess LOS and costs after MRSA infection.

Original languageEnglish
Pages (from-to)132-137
Number of pages6
JournalJournal of Hospital Infection
Volume84
Issue number2
DOIs
Publication statusPublished - Jun 2013
Externally publishedYes

Keywords

  • Economics
  • Epidemiology
  • Health burden
  • Meticillin-resistant Staphylococcus aureus
  • Multistate modelling

Cite this

Macedo-Viñas, M. ; De Angelis, Giulia ; Rohner, Peter ; Safran, Edith ; Stewardson, A. ; Fankhauser, Carolina ; Schrenzel, Jacques ; Pittet, Didier ; Harbarth, Stephan. / Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital : Excess length of stay and costs. In: Journal of Hospital Infection. 2013 ; Vol. 84, No. 2. pp. 132-137.
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abstract = "Background: Meticillin-resistant Staphylococcus aureus (MRSA) infections increase hospital costs primarily by prolonging patient length of stay (LOS). Aim: To estimate the health-economic burden of MRSA infections at a Swiss University hospital using different analytical approaches. Methods: Excess LOS was estimated by: (i) multistate modelling comparing MRSA-infected and MRSA-free patients with MRSA infection as time-dependent exposure; (ii) matching MRSA-infected patients with a cohort of MRSA-uninfected patients. The economic impact was assessed by: (i) comparing cost estimates between MRSA-infected and MRSA-free patients and multiplying excess LOS by bed-day cost; (ii) comparing real costs between MRSA-infected and MRSA-colonized non-infected patients. Findings: The crude mean LOS was 37.3, 33.0 and 8.8 days for MRSA-infected, MRSA-colonized and MRSA-free patients, respectively. Excess LOS attributable to MRSA infection was 11.5 [95{\%} confidence interval (CI): 7.9-15] or 15.3 days according to multistate modelling and matched analysis, respectively. The likelihood of discharge after MRSA infection was significantly reduced (adjusted hazard ratio: 0.69; 95{\%} CI: 0.59-0.81). Average bed-day costs for MRSA-infected patients were 1.49- and 1.26-fold higher than for the general population hospitalized in acute wards and MRSA-colonized patients, respectively. MRSA infection resulted in an average additional cost of about 800 Swiss francs per day. Conclusions: This analysis emphasizes the financial impact of MRSA infections, demonstrates the importance of accounting for time-dependent bias and confirms that multistate modelling is a valid strategy for estimating excess LOS and costs after MRSA infection.",
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Macedo-Viñas, M, De Angelis, G, Rohner, P, Safran, E, Stewardson, A, Fankhauser, C, Schrenzel, J, Pittet, D & Harbarth, S 2013, 'Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital: Excess length of stay and costs', Journal of Hospital Infection, vol. 84, no. 2, pp. 132-137. https://doi.org/10.1016/j.jhin.2013.02.015

Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital : Excess length of stay and costs. / Macedo-Viñas, M.; De Angelis, Giulia; Rohner, Peter; Safran, Edith; Stewardson, A.; Fankhauser, Carolina; Schrenzel, Jacques; Pittet, Didier; Harbarth, Stephan.

In: Journal of Hospital Infection, Vol. 84, No. 2, 06.2013, p. 132-137.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Burden of meticillin-resistant Staphylococcus aureus infections at a Swiss University hospital

T2 - Excess length of stay and costs

AU - Macedo-Viñas, M.

AU - De Angelis, Giulia

AU - Rohner, Peter

AU - Safran, Edith

AU - Stewardson, A.

AU - Fankhauser, Carolina

AU - Schrenzel, Jacques

AU - Pittet, Didier

AU - Harbarth, Stephan

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Y1 - 2013/6

N2 - Background: Meticillin-resistant Staphylococcus aureus (MRSA) infections increase hospital costs primarily by prolonging patient length of stay (LOS). Aim: To estimate the health-economic burden of MRSA infections at a Swiss University hospital using different analytical approaches. Methods: Excess LOS was estimated by: (i) multistate modelling comparing MRSA-infected and MRSA-free patients with MRSA infection as time-dependent exposure; (ii) matching MRSA-infected patients with a cohort of MRSA-uninfected patients. The economic impact was assessed by: (i) comparing cost estimates between MRSA-infected and MRSA-free patients and multiplying excess LOS by bed-day cost; (ii) comparing real costs between MRSA-infected and MRSA-colonized non-infected patients. Findings: The crude mean LOS was 37.3, 33.0 and 8.8 days for MRSA-infected, MRSA-colonized and MRSA-free patients, respectively. Excess LOS attributable to MRSA infection was 11.5 [95% confidence interval (CI): 7.9-15] or 15.3 days according to multistate modelling and matched analysis, respectively. The likelihood of discharge after MRSA infection was significantly reduced (adjusted hazard ratio: 0.69; 95% CI: 0.59-0.81). Average bed-day costs for MRSA-infected patients were 1.49- and 1.26-fold higher than for the general population hospitalized in acute wards and MRSA-colonized patients, respectively. MRSA infection resulted in an average additional cost of about 800 Swiss francs per day. Conclusions: This analysis emphasizes the financial impact of MRSA infections, demonstrates the importance of accounting for time-dependent bias and confirms that multistate modelling is a valid strategy for estimating excess LOS and costs after MRSA infection.

AB - Background: Meticillin-resistant Staphylococcus aureus (MRSA) infections increase hospital costs primarily by prolonging patient length of stay (LOS). Aim: To estimate the health-economic burden of MRSA infections at a Swiss University hospital using different analytical approaches. Methods: Excess LOS was estimated by: (i) multistate modelling comparing MRSA-infected and MRSA-free patients with MRSA infection as time-dependent exposure; (ii) matching MRSA-infected patients with a cohort of MRSA-uninfected patients. The economic impact was assessed by: (i) comparing cost estimates between MRSA-infected and MRSA-free patients and multiplying excess LOS by bed-day cost; (ii) comparing real costs between MRSA-infected and MRSA-colonized non-infected patients. Findings: The crude mean LOS was 37.3, 33.0 and 8.8 days for MRSA-infected, MRSA-colonized and MRSA-free patients, respectively. Excess LOS attributable to MRSA infection was 11.5 [95% confidence interval (CI): 7.9-15] or 15.3 days according to multistate modelling and matched analysis, respectively. The likelihood of discharge after MRSA infection was significantly reduced (adjusted hazard ratio: 0.69; 95% CI: 0.59-0.81). Average bed-day costs for MRSA-infected patients were 1.49- and 1.26-fold higher than for the general population hospitalized in acute wards and MRSA-colonized patients, respectively. MRSA infection resulted in an average additional cost of about 800 Swiss francs per day. Conclusions: This analysis emphasizes the financial impact of MRSA infections, demonstrates the importance of accounting for time-dependent bias and confirms that multistate modelling is a valid strategy for estimating excess LOS and costs after MRSA infection.

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