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Attributable cost and length of stay for central line-associated bloodstream infections
Anthony Goudie1, Linda Dynan2, Patrick W Brady3
1Center for Applied Research and Evaluation, and agoudie@uams.edu.
Insights
Central line-associated bloodstream infections (CLABSI) in children significantly increase hospital costs and length of stay. Despite declining rates, CLABSI remains a considerable burden, necessitating ongoing prevention efforts.
Area of Science:
- Pediatric Healthcare
- Infectious Disease Epidemiology
- Health Economics
Background:
- Central line-associated bloodstream infections (CLABSI) are a significant cause of hospital-acquired infections in pediatric patients.
- The economic impact and length of stay associated with pediatric CLABSI are not well-established.
Purpose of the Study:
- To determine the attributable cost and length of stay (LOS) for pediatric CLABSI.
- To analyze trends in pediatric CLABSI rates and associated costs from 2008 to 2011.
Main Methods:
- A propensity score-matched case-control study using the Nationwide Inpatient Sample database (2008-2011).
- Matched pediatric inpatients with and without CLABSI based on age, year, and detailed clinical diagnoses.
- Outcome measures included estimated costs and LOS.
Main Results:
- Mean attributable cost for CLABSI was $55,646 and mean LOS was 19 days.
- Pediatric CLABSI rates decreased from 1.08 to 0.60 per 1000 discharges (P < .001).
- Mean treatment costs for CLABSI patients decreased by 11.8% ($111,852 to $98,621), while non-CLABSI costs remained stable.
Conclusions:
- Despite improvements, CLABSI continues to impose a substantial burden on healthcare systems and patients.
- Continued focus on CLABSI prevention and cost-effective management strategies is crucial for high-value pediatric care.
Background And 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.
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