Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay.
BACKGROUND
Competing resource demands have resulted in the de-escalation of vancomycin-resistant enterococcus (VRE) control programmes in some Canadian healthcare centres.


OBJECTIVE
To determine the attributable costs and length of stay (LOS) of VRE colonizations/infections in an acute care hospital in Canada.


METHODS
Surveillance and financial hospital-based databases were used to conduct analyses with cases and controls from fiscal year 2008-2009 (1 April 2008 to 31 March 2009) at an acute care hospital in downtown Vancouver, Canada. A statistical analysis of attributable costs and LOS was conducted using a generalized linear model. In a secondary analysis, differences in costs and LOS were examined for VRE infections versus colonizations.


RESULTS
A total of 217 patients with VRE and a random sample of 1075 patients without VRE were examined. VRE has a positive and significant impact on patient hospitalization costs and LOS. Overall, the presence of VRE increased the estimated mean cost per patient by 61.9% (95% confidence interval: 42.3-84.3) in relative terms and $17,949 (13,949-21,464) in absolute Canadian dollars. For LOS, the attributable number of days associated with a VRE case mean was 68.0% (41.9-98.9) higher in relative terms and 13.8 days (10.0-16.9) in absolute days. In the secondary analysis comparing VRE infection and colonization costs, no statistically significant difference was found.


CONCLUSIONS
Based on this analysis, the attributable cost and LOS of VRE are considerable. These factors should be considered before de-escalation of a hospital VRE control programme.
Department of Resource Economics and Environmental Sociology, University of Alberta, Edmonton, Canada.
P
P
Lloyd-Smith
J
J
Younger
E
E
Lloyd-Smith
H
H
Green
V
V
Leung
M G
MG
Romney
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016983:Enterococcus / Q000187:drug effects* / Q000302:isolation & purification; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000191:economics* / Q000382:microbiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020713:Vancomycin Resistance
Economics; Hospital; Infection control; Vancomycin-resistant enterococcus (VRE)