title: A decade of investment in infection prevention: a cost-effectiveness analysis.
abstract: BACKGROUND
  Health care-associated infection (HAI) rates have fallen with the development of multifaceted infection prevention programs. These programs require ongoing investments, however. Our objective was to examine the cost-effectiveness of hospitals' ongoing investments in HAI prevention in intensive care units (ICUs).
  
  
  METHODS
  Five years of Medicare data were combined with HAI rates and cost and quality of life estimates drawn from the literature. Life-years (LYs), quality-adjusted LYs (QALYs), and health care expenditures with and without central line-associated bloodstream infection (CLABSI) and/or ventilator-associated pneumonia (VAP), as well as incremental cost-effectiveness ratios (ICERs) of multifaceted HAI prevention programs, were modeled.
  
  
  RESULTS
  Total LYs and QALYs gained per ICU due to infection prevention programs were 15.55 LY and 9.61 QALY for CLABSI and 10.84 LY and 6.55 QALY for VAP. Reductions in index admission ICU costs were $174,713.09 for CLABSI and $163,090.54 for VAP. The ICERs were $14,250.74 per LY gained and $23,277.86 per QALY gained.
  
  
  CONCLUSIONS
  Multifaceted HAI prevention programs are cost-effective. Our results underscore the importance of maintaining ongoing investments in HAI prevention. The welfare benefits implied by the advantageous ICERs would be lost if the investments were suspended.
authors.affiliation: RAND Corporation, Pittsburgh, PA. Electronic address: andrewd@rand.org.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine University of Iowa, Carver College of Medicine and Iowa City VA Medical Center, Iowa City, IA.
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.affiliation: Jefferson School of Nursing, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Monika
authors.initials: M
authors.lastname: Pogorzelska-Maziarz
authors.affiliation: Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL.
authors.forename: Jack
authors.initials: J
authors.lastname: Zwanziger
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Health Policy, School of Nursing, Columbia University, New York, NY.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Larson
authors.affiliation: Center for Health Policy, School of Nursing, Columbia University, New York, NY.
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D008297:Male
keywords: Central line–associated bloodstream infections; Cost analysis; Economic evaluation; Long-term costs; Quality of life; Ventilator-associated pneumonia