Economic Burden Attributable to Healthcare-Associated Infections in Tertiary Public Hospitals of Central China: A Multi-Center Case-Control Study

BackgroundHealthcare-associated infection (HAI) is a major cause of morbidity, mortality and cost, which vary widely by region and hospital. We aimed to calculate losses attributable to HAI in central China.MethodsWe performed a three-stage random sampling and employed a 1:1 matched case-control study in tertiary public hospitals of Central China. The direct medical cost attributable to HAIs was calculated, and then compared among different types of HAIs by employing a subgroup analysis.ResultsA total of 2976 patients in 10 hospitals were enrolled, and the incidence rate of HAI (range, 0.88%-4.15%) was significantly, but negatively associated with the cost per 1000 beds of its prevention (range, $24929.76-$53146.41; r=-0.76). The per capita economic loss attributable to HAIs was $2047.07 (interquartile range, $327.63-$6429.17), mainly from the pharmaceutical cost (median, $1044.39). The HAIs, which occurred in patients with commercial medical insurance, affected the hematologic system and caused by A. baumannii, contributed most to the losses (median, $3881.55, $4734.20 and $9882.75, respectively), and a significant correlation existed between the economic loss and age (r=0.26). Furthermore, the economic losses attributable to device-associated infections and hospital-acquired multi-drug resistant bacteria were 2 to 4 times those of the controls.ConclusionsThe economic burden attributable to HAI in central China is heavy, and opportunities for easing this burden exist in several areas, including that strengthening antibiotic stewardship and practicing effective bundle of HAI prevention for patients carrying high risk factors, for example, elders or those with catheterizations in healthcare institutions, and accelerating the medical insurance payment system reform based on Diagnosis Related Groups (DRGs) by policy-making departments.