High cost nosocomial infections.

The average charge per patient due to nosocomial infection for 215 nosocomial infections in 183 study patients was $693. These cost, however, were concentrated in very few patients; 5% of patients accounted for nearly one-third of total charges. The 10% of patients with highest nosocomial infection cost were patients on Medical or Surgical services; these services were utilized in 71% of patients with nosocomial infection and accounted for 86% of the attributable charges. Among the 22 most costly infections, 17 occurred in surgical wounds and lower respiratory tract. Although these sites accounted for 46% of the infections, they resulted in 77% of the total nosocomial infection charges. Patients with a primary diagnosis of injury had particularly costly infections. Combined analysis of these variables revealed two groups for whom nosocomial infections were especially costly: surgical patients who acquired wound infections after injuries, and medical patients with lower respiratory infections.

Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison.

Using a standardized method, we estimated concurrently the prolongation of stay and extra charges attributable to nosocomial infection in three hospitals that differed in size, administrative characteristics and patients' economic status. Results showed the consequences in the three hospitals to have been similar in the degree to which nosocomial infection prolonged hospitalization (3.1 to 4.5 days) and added to the infected patients' charges ($590 to $641 in 1976 dollars). In all three hospitals, the extra charges were divided about equally between routine and ancillary charges, and a relatively small percentage of patients (10 percent) with nosocomial infection accounted for a disproportionately large share of the total extra charges--46, 65 and 38 percent in the three hospitals, respectively. The economic consequences were influenced more by site of infection than by differences among hospitals, and their magnitude emphasizes the need for continued preventive efforts.

Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods.

Estimates of the economic consequences of nosocomial infections were derived by studying the same patient population with two different methods: physician's assessment and comparisons of patients with nosocomial infection and those without, matched on five characteristics. Estimates of extra days and extra routine charges obtained by the comparison were about 2 1/2 times greater than those obtained by the physician's assessment (P less than 0.0001). Even when the match of patients was exact and measures were taken to avoid confounding, patients with nosocomial infection had more discharge diagnoses recorded (P = 0.02) and experienced more episodes of pulmonary embolism, renal failure, and death in the hospital than did their counterparts. These differences suggest that, despite careful matching, the members of the pairs were not comparable in their intrinsic predisposition to prolonged hospitalization. Unless patients can be matched on this prediposition, the estimates from a comparison study will be exaggerated.

Epidemic dengue fever in Puerto Rico, 1977: a cost analysis.

During the period July-December 1977, a widespread epidemic of dengue fever occurred in Puerto Rico. The cost of the epidemic was calculated, using upper and lower limit incidence figures, in terms of direct costs (medical care and epidemic control measures) and indirect costs (lost production of ill workers and parents of ill children). Direct costs were estimated to range between $2.4 and $4.7 million. Indirect costs were calculated by using current (1977) employment and wage data and population extrapolations from the 1970 census, and entailed a loss to the Puerto Rico economy of from $3.7 to $10.9 million. The total cost of this epidemic, therefore, was estimated to be in a range of $6.0 to $15.6 million, of which epidemic control measures comprised 7.8--20.2%.

Maternal serum alpha-fetoprotein screening: a cost-benefit analysis.

The prenatal detection of fetal neural tube defects (NTD) is now possible by means of a multi-tiered program utilizing maternal serum alpha-fetoprotein (MSAFP) screening coupled with ultrasonography and amniocentesis where indicated. This paper considers the economic consequences of screening for fetal NTD a theoretical cohort of 100,000 pregnant women at risk of having an affected fetus who would elect to terminate their pregnancies if an affected fetus were found. The cost of the program was balanced against the benefits of the program, such as the averted costs of institutionalization, medical care, and the like. The total cost of the program to screen 100,000 such women was calculated to be $2,047,780, or slightly over $20 per woman screened, while the total economic benefits exceeded $4,000,000.

PIP: Neural tube defects in prepartum fetuses can be detected by a three-part program using maternal serum alpha fetoprotein (AFP) screening with ultrasonography and amniocentesis when indicated. The economic consequences of screening for a hypothetical cohort of 100,000 pregnant women were measured against the benefits to be accrued from the program. If defective pregnancies were terminated the institutional and medical costs of care would be avoided. The total cost of screening 100,000 women was estimated to be $2,047,780, slightly over $20 per woman. The economic benefits exceeded $4,000,000. Ethical questions surrounding alpha fetoprotein (AFP) screenings still remain. A pilot program to study cost-benefits under real life conditions is recommended.

Congenital hypothyroidism control programs. A cost-benefit analysis.

Comprehensive screening programs to control congenital hypothyroidism (CH), a preventable form of mental retardation, are being considered by some public health agencies. The proposed programs would test neonates' blood for thyroxine and, if warranted, provide follow-up testing and therapy. The estimated cost of detecting a single case of CH is $9,300, which includes specimen collection, laboratory analysis, and retesting of border-line cases. The present value of the treatment costs of CH adds $2,500 per case, a total cost of $11,800 per case detected and child treated. The economic benefits (averted costs of institutionalization and special education and increased productivity of the affected person) are estimated to have a present value of $105,000 per case, yielding a cost-benefit ratio of 1:8.9.