title: Attributable cost and length of stay for central line-associated bloodstream infections.
abstract: OBJECTIVE
  Central line-associated bloodstream infections (CLABSI) are common types of hospital-acquired infections associated with high morbidity. Little is known about the attributable cost and length of stay (LOS) of CLABSI in pediatric inpatient settings. We determined the cost and LOS attributable to pediatric CLABSI from 2008 through 2011.
  
  
  METHODS
  A propensity score-matched case-control study was performed. Children <18 years with inpatient discharges in the Nationwide Inpatient Sample databases from the Healthcare Cost and Utilization Project from 2008 to 2011 were included. Discharges with CLABSI were matched to those without CLABSI by age, year, and high dimensional propensity score (obtained from a logistic regression of CLABSI status on patient characteristics and the presence or absence of 262 individual clinical classification software diagnoses). Our main outcome measures were estimated costs obtained from cost-to-charge ratios and LOS for pediatric discharges.
  
  
  RESULTS
  The mean attributable cost and LOS between matched CLABSI cases (1339) and non-CLABSI controls (2678) was $55 646 (2011 dollars) and 19 days, respectively. Between 2008 and 2011, the rate of pediatric CLABSI declined from 1.08 to 0.60 per 1000 (P < .001). Estimates of mean costs of treating patients with CLABSI declined from $111 852 to $98 621 (11.8%; P < .001) over this period, but cost of treating matched non-CLABSI patients remained constant at ∼$48 000.
  
  
  CONCLUSIONS
  Despite significant improvement in rates, CLABSI remains a burden on patients, families, and payers. Continued attention to CLABSI-prevention initiatives and lower-cost CLABSI care management strategies to support high-value pediatric care delivery is warranted.
authors.affiliation: Center for Applied Research and Evaluation, and agoudie@uams.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Goudie
authors.affiliation: James M. Anderson Center for Health Systems Excellence, andHaile US Bank College of Business, Northern Kentucky University, Highland Heights, Kentucky.
authors.forename: Linda
authors.initials: L
authors.lastname: Dynan
authors.affiliation: James M. Anderson Center for Health Systems Excellence, andDivision of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas;
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000191:economics* / Q000635:transmission*; D055499:Catheter-Related Infections / Q000191:economics* / Q000635:transmission*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics* / Q000635:transmission*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics*; D008297:Male; D057216:Propensity Score; D011785:Quality Assurance, Health Care / Q000191:economics; D012189:Retrospective Studies; D014481:United States
keywords: bloodstream infection; central venous catheter; cost analysis; economic burden; quality of care