Economics and Preventing Healthcare Acquired Infection

by Graves, Nicholas; Halton, Kate; Jarvis, William

• ISBN13: 9780387726496
• ISBN10: 0387726497
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-04-28
• Publisher: Springer Nature

Summary

The evolution of organisms that cause healthcare acquired infections (HAI) puts extra stress on hospitals already struggling with rising costs and demands for greater productivity and cost containment. Infection prevention and control programs can save scarce resources, lives, and possible a facility's reputation, but statistics and epidemiology are not always sufficient to make the case for the added expense. Economics and Preventing Healthcare Acquired Infection presents a rigorous analytic framework for addressing this increasingly serious problem.

Author Biography

Nicholas Graves is a Senior Research Fellow in Health Economics at the School of Public Health, Queensland University of Technology.  He is also a Senior Lecturer in the Department of Infectious Diseases at the Princess Alexandra Hospital, Australia.William Jarvis is a well-known figure in infection control.  He was formerly Chief of the Epidemiology Branch at the CDC, as well as Director of the Hospital Infections Program at the CDC.  He is a past President of The Society for Healthcare Epidemiologists of America (SHEA), and is currently Vice-President of the Association for Professionals in Infection Control (APIC). Michael Whitby is Director of Infection Management Services at the Princess Alexandra Hospital, Australia.

Table of Contents

Introduction	p. 1
Reasons for Writing This Book	p. 1
Audiences for the Book	p. 5
Organization of the Book	p. 6
Economics	p. 9
A Broad View of Economics	p. 9
The Building Blocks of Economics	p. 11
The Concept of Scarcity	p. 11
The Concept of Opportunity Cost	p. 13
The Concept of Efficiency	p. 17
The Concept of Competitive Markets	p. 18
The Concept of Market Failure	p. 22
The Concept of Economic Appraisal	p. 24
Conclusions	p. 25
Health Economics	p. 27
Origins and Content of Health Economics	p. 27
The Parts of Health Economics Most Useful for Infection-Control	p. 30
Competing Approaches to Economic Appraisal	p. 32
Welfarism	p. 33
Extra-Welfarism	p. 35
Advantages and Disadvantages of Each Type of Economic Appraisal	p. 36
Conclusions	p. 37
Economic Appraisal: A General Framework	p. 39
What an Economic Appraisal Looks Like	p. 39
Incremental Analysis	p. 43
Ceiling Rations and Choosing Healthcare Programs	p. 46
Conclusions	p. 48
Economic Appraisal: The Nuts and Bolts	p. 49
Using a Clinical Trial vs. a Modeling Study	p. 49
Economic Appraisal Alongside Clinical Trials	p. 49
Economic Appraisal by Modeling Study	p. 50
Building a Model	p. 52
Objective 1: Define the Structure of the Model	p. 53
Objective 2: Find the Evidence Required to Make the Decision	p. 54
Objective 3: Evaluate the Model that has been Designed	p. 56
Objective 4: Account for Heterogeneity and Uncertainty	p. 59
Objective 5: Value Future Research	p. 63
Important Features of an Economic Appraisal	p. 63
Conclusions	p. 65
Changes Arising from the Adoption of Infection Control Programs	p. 67
Overview of the Major Changes	p. 67
Changes to the Number of Infections	p. 70
Epidemiological Studies	p. 70
Synthesizing Existing Evidence	p. 71
Conclusions	p. 75
Measuring the Cost of Healthcare Acquired Infections	p. 77
Why Data on the Cost of Hai are Useful	p. 77
Defining and Measuring Costs of HAI	p. 78
The Cost Accountant's Method	p. 78
The Economist's Method	p. 83
Differences Between the Cost Accounting and Economics Methods	p. 87
Estimating the Increase in Length of Stay due to HAI	p. 88
Design Approaches	p. 90
Statistical Approaches	p. 92
Conclusions	p. 96
Measuring the Cost of Implementing Infection Control Programs	p. 97
Estimating the Costs of Infection Control Programs	p. 97
Two Case Studies for Estimating the Cost of Infection Control	p. 98
A Case Study of the Costs of Adopting Antimicrobial Catheters	p. 98
A Case Study of the Costs of a Staff Education Program	p. 100
Analyzing Costs, Inputs, and Outputs	p. 101
Incremental Costs	p. 103
Average Costs	p. 105
Cost Data and Decision Making	p. 105
Capital Costs	p. 106
Conclusions	p. 107
Preventing HAI and the Health Benefits that Result	p. 109
Health Benefits	p. 109
What QALYs are and How they are Estimated	p. 109
Information Required to Estimate QALYs	p. 116
The Risk of Death due to Infection	p. 116
The Nature of the Health States and the Methods for Finding Utility Scores that Describe Them	p. 117
Conclusions	p. 122
Dissecting a Published Economic Appraisal	p. 123
Economic Evaluation in the Infection Control Literature	p. 123
Case Study of a Decision to Adopt Antimicrobial Central Venous Catheters	p. 124
Structuring the Evaluation	p. 124
Evidence Required for the Evaluation	p. 128
Epidemiological Parameters	p. 129
Effectiveness of Antimicrobial CVCs	p. 129
Costs	p. 130
Health Outcomes	p. 132
Evaluating the Decision	p. 132
Handling Uncertainty in the Decision	p. 133
Parameter Uncertainty	p. 134
Data Quality	p. 135
Generalizability	p. 136
Interpreting the Results for Decision Making	p. 136
Conclusions	p. 137
Economic Facts and the Infection Control Environment	p. 139
The Changing Infection Control Environment	p. 139
The Economic Facts	p. 141
Diminishing Returns	p. 141
Cost Structures	p. 144
Lack of Good Information	p. 147
Incentives for Bad Behavior	p. 148
Good Decision Making for Infection Control	p. 149
Conclusions	p. 152
Appendix	p. 153
References	p. 155
Index	p. 161
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