title: Multicenter study of health care cost of patients admitted to hospital with Staphylococcus aureus bacteremia: Impact of length of stay and intensity of care.
abstract: BACKGROUND
  Methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S aureus bacteremia (SAB) have both been associated with high morbidity and mortality and heavy consumption of health care resources. We compared clinical and economic data for hospitalized cases of SAB in the context of a publicly funded health care system.
  
  
  METHODS
  A cost analysis was undertaken on an adult cohort of patients from 4 hospitals with SAB diagnosed within 3 days of hospitalization. Primary outcome was direct cost of inpatient care per case, determined at discharge and itemized using a standardized methodology.
  
  
  RESULTS
  A total of 435 patients were admitted with SAB; 58 had methicillin-resistant S aureus (MRSA). The median length of stay was similar in patients with MRSA and MSSA. There was no significant difference between the groups for mortality. Median direct medical costs of SAB were $12,078. Patients with MRSA had 1.32 times higher direct costs than MSSA. A similar estimate was derived using a propensity score approach (P = .148). Human health care resources comprised >70% of total costs per case, whereas antibiotics comprised 1%-2%.
  
  
  CONCLUSIONS
  Understanding the dynamics of resource consumption is critical to improving its efficiency and the quality of patient care. Our findings suggest that hospital length of stay and care intensity should be the major focus of any resource assessment exercise.
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Nisha
authors.initials: N
authors.lastname: Thampi
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Showler
authors.affiliation: Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Burry
authors.affiliation: Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Bai
authors.affiliation: Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada; Lakeridge Health, Oshawa, ON, Canada.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Ricciuto
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada; Department of Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada. Electronic address: amorris@mtsinai.on.ca.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D055815:Young Adult
keywords: Bacteremia; Cost analysis; Health care; Hospitalization; Methicillin-resistant Staphylococcus aureus