title: Hospital-acquired infections in Belgian acute-care hospitals: financial burden of disease and potential cost savings.
abstract: BACKGROUND
  Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced. The objectives of this study were to examine the prevalence and the excess costs associated with HAIs.
  
  
  METHODS
  A retrospective observational study was performed to estimate costs associated with hospital-acquired infections in Belgian hospitals, both in procedural admissions and in medical admissions. Hospital, diagnosis-related group, age and gender were used as matching factors to compare stays associated with HAIs and stays without HAIs. Data were obtained from the Minimum Basic Data Set 2008 used by Belgian hospitals to register case-mix data for each admission to obtain reimbursement from the authorities. Data included information from 45 hospitals representing 16,141 beds and 2,467,698 patient stays. Using the 2008 national feedback programme of the Belgian government, cost data were collected (prolonged length of stay, additional pharmaceuticals and procedures) and subsequently linked to the data set. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of HAIs in hospitals having a higher rate of hospital-acquired infections in comparison to other hospitals would be realized.
  
  
  RESULTS
  In our sample 5.9% of the hospital stays were associated with a hospital-acquired infection. In the procedural admission subset this was the case for 4.7% of the hospital stays. The additional mean cost of the hospital-acquired infection was Euro 2,576 for all stays (P < 0.001) and Euro 3,776 for procedural stays (P < 0.001). The total burden of disease in Belgium is estimated at Euro 533,076,110 for all admissions and Euro 235,667,880 for the subset of procedural admissions. The excess length of stay varied between hospitals from 2.52 up to 8.06 days (Md 4.58, SD 1.01), representing an associated cost of Euro 355,060,174 (66.61% of the total cost). The cost of additional medical procedures and additional pharmaceutical products was estimated at Euro 62,864,544 (11.97%) and Euro 115,151,939 (21.60%) respectively. Overall, our results showed that considerable variability between hospitals regarding the incidence of HAIs (3.77-9.78%) for all hospital stays is present, indicating a potential for improvement. We provide a full overview of the potential monetary savings when reductions in HAIs are realized by applying different thresholds. For instance, if all Belgian hospitals having a higher rate of hospital-acquired infections improve their rate to the level of the hospital corresponding to percentile 75 (= 7.5% HAL) savings would be Euro 17,799,326.
  
  
  CONCLUSIONS
  HALs are associated with important additional healthcare costs. Although not all hospital-acquired infections can be prevented, an opportunity to increase cost-effectiveness of hospital care delivery presents itself. This study is the first to estimate the annual economic burden of HALs for Belgium at a national level, incorporating all associated hospital costs. Apart from the fact that the cost of prolonged length of stay is of major importance, we have also shown that the cost of additional procedures and pharmaceutical products cannot be neglected when estimating the financial burden of HAIs.
authors.affiliation: Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Jeroen.Trybou@Ugent.be
authors.forename: J
authors.initials: J
authors.lastname: Trybou
authors.forename: E
authors.initials: E
authors.lastname: Spaepen
authors.forename: B
authors.initials: B
authors.lastname: Vermeulen
authors.forename: L
authors.initials: L
authors.lastname: Porrez
authors.forename: L
authors.initials: L
authors.lastname: Annemans
mesh_terms: D000208:Acute Disease; D001530:Belgium / Q000453:epidemiology; D017046:Cost Savings / Q000191:economics*; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D012189:Retrospective Studies