Analysis of MRSA-attributed costs of hospitalized patients in Germany

  • C. Hübner
  • N.-O. Hübner
  • K. Hopert
  • S. Maletzki
  • S. Flessa
Article

Abstract

Infections with methicillin-resistant Staphylococcus aureus (MRSA) are assumed to have a high economic impact due to increased hygienic measures and prolonged hospital length of stay. However, surveys on the real expenditure for the prevention and treatment of MRSA are scarce, in particular with regard to the German Diagnosis-Related Groups (G-DRG) payment system. The aim of our study is to empirically assess the additional cost for MRSA management measures and to identify the main cost drivers in the whole process from the hospital’s point of view. We conducted a one-year retrospective analysis of MRSA-positive cases in a German university hospital and determined the cost of hygienic measures, laboratory costs, and opportunity costs due to isolation time and extended lengths of stay. A total of 182 cases were included in the analysis. The mean length of hospital stay was 22.75 days and the mean time in isolation was 17.08 days, respectively. Overall, the calculated MRSA-attributable costs were € 8,673.04 per case, with opportunity costs making up, by far, the largest share (77.45 %). Our study provides a detailed up-to-date analysis of MRSA-attributed costs in a hospital. It allows a current comparison to previous studies worldwide. Moreover, it offers the prerequisites to investigate the adequate reimbursement of MRSA burden in the DRG payment system and to assess the efficiency of targeted hygienic measures in the prevention of MRSA.

Notes

Acknowledgments

We thank S. Ryll, H. Leesch, S. Kroeger, and Dr. K. Schulz for their help in collecting the data.

Conflict of interest

The authors declare that they have no competing interests. This study is integrated in the model project Health, Innovative Care and Regional Economy (HICARE), Health Region Baltic Sea Coast, which is supported by the German Federal Ministry of Education and Research (BMBF) and the government of Mecklenburg-Vorpommern.

References

  1. 1.
    Gould IM (2005) The clinical significance of methicillin-resistant Staphylococcus aureus. J Hosp Infect 61(4):277–282PubMedCrossRefGoogle Scholar
  2. 2.
    Reed SD, Friedman JY, Engemann JJ, Griffiths RI, Anstrom KJ, Kaye KS, Stryjewski ME, Szczech LA, Reller LB, Corey GR, Schulman KA, Fowler VG Jr (2005) Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 26(2):175–183PubMedCrossRefGoogle Scholar
  3. 3.
    de Kraker ME, Davey PG, Grundmann H; BURDEN study group (2011) Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med 8(10):e1001104PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Navarro Torné A, Witte W, Friedrich AW (2010) Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 15(41):19688PubMedGoogle Scholar
  5. 5.
    Hubben G, Bootsma M, Luteijn M, Glynn D, Bishai D, Bonten M, Postma M (2011) Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus. PLoS One 6(3):e14783PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Murthy A, De Angelis G, Pittet D, Schrenzel J, Uckay I, Harbarth S (2010) Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 16(12):1747–1753PubMedCrossRefGoogle Scholar
  7. 7.
    Uçkay I, Sax H, Iten A, Camus V, Renzi G, Schrenzel J, Perrier A, Pittet D (2008) Effect of screening for methicillin-resistant Staphylococcus aureus carriage by polymerase chain reaction on the duration of unnecessary preemptive contact isolation. Infect Control Hosp Epidemiol 29(11):1077–1079PubMedCrossRefGoogle Scholar
  8. 8.
    van Rijen MM, Kluytmans JA (2009) Costs and benefits of the MRSA search and destroy policy in a Dutch hospital. Eur J Clin Microbiol Infect Dis 28(10):1245–1252PubMedCrossRefGoogle Scholar
  9. 9.
    Wassenberg MWM, Kluytmans JAJW, Box ATA, Bosboom RW, Buiting AGM, van Elzakker EPM, Melchers WJG, van Rijen MML, Thijsen SFT, Troelstra A, Vandenbroucke-Grauls CMJE, Visser CE, Voss A, Wolffs PFG, Wulf MWH, van Zwet AA, de Wit GA, Bonten MJM (2010) Rapid screening of methicillin-resistant Staphylococcus aureus using PCR and chromogenic agar: a prospective study to evaluate costs and effects. Clin Microbiol Infect 16(12):1754–1761PubMedCrossRefGoogle Scholar
  10. 10.
    Geldner G, Ruoff M, Hoffmann HJ, Kiefer P, Georgieff M, Wiedeck H (1999) Cost analysis concerning MRSA-infection in ICU. Anasthesiol Intensivmed Notfallmed Schmerzther 34(7):409–413PubMedCrossRefGoogle Scholar
  11. 11.
    Ott E, Bange FC, Reichardt C, Graf K, Eckstein M, Schwab F, Chaberny IF (2010) Costs of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus. J Hosp Infect 76(4):300–303PubMedCrossRefGoogle Scholar
  12. 12.
    Herr CEW, Heckrodt TH, Hofmann FA, Schnettler R, Eikmann TF (2003) Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 24(9):673–678PubMedCrossRefGoogle Scholar
  13. 13.
    Wernitz MH, Keck S, Swidsinski S, Schulz S, Veit SK (2005) Cost analysis of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers in the context of diagnosis related groups (DRG) payment. Clin Microbiol Infect 11(6):466–471PubMedCrossRefGoogle Scholar
  14. 14.
    Resch A, Wilke M, Fink C (2009) The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals. Eur J Health Econ 10(3):287–297PubMedCrossRefGoogle Scholar
  15. 15.
    Gastmeier P (2014) Krankenhaushygiene und Infektionsvermeidung. In: Klauber J, Geraedts M, Friedrich J, Wasem J (eds) Krankenhaus-report 2014. Schattauer-Verlag, Stuttgart, pp 113–123Google Scholar
  16. 16.
    Loveday HP, Pellowe CM, Jones SR, Pratt RJ (2006) A systematic review of the evidence for interventions for the prevention and control of meticillin-resistant Staphylococcus aureus (1996–2004): report to the Joint MRSA Working Party (Subgroup A). J Hosp Infect 63(Suppl 1):S45–S70PubMedCrossRefGoogle Scholar
  17. 17.
    DeWitt TG (1987) How problematic are nosocomial infections in the DRG reimbursement system? Am J Public Health 77(5):542–543PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Strübing V, Dittberner T, Metelmann C, Hübner NO (2011) Uniform documentation of measures in cases of MRSA—an important step towards improving the quality of treatment. GMS Krankenhhyg Interdiszip 6(1):Doc21PubMedPubMedCentralGoogle Scholar
  19. 19.
    Haubrock M (2007) Krankenhausfinanzwirtschaft. In: Haubrock M, Schär W (eds) Betriebswirtschaft und Management im Krankenhaus. Huber, Bern, pp 394–453Google Scholar
  20. 20.
    Kalenic S, Cookson B, Gallagher R, Popp W, Asensio-Vegas A, Assadian O, Blok A, Brussafero S, Eastaway A, Elstrom P, Girod Schreinerova M, Hartemann P, Iversen RBG, Jans B, Jul-Jorgensen A, Koller W, Kramer A, Laugesen D, Licker M, Mannerquist K, Nussbaum B, Parneix P, de Ruiter T, Tvenstrup Jensen E, Ummels L, Zastrow K-D (2010) Comparison of recommendations in national/regional Guidelines for prevention and control of MRSA in thirteen European countries. Int J Infect Control 6(2)Google Scholar
  21. 21.
    Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM; SHEA (2003) SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 24(5):362–386PubMedCrossRefGoogle Scholar
  22. 22.
    Hübner C, Hübner N-O, Muhr M, Claus F, Leesch H, Kramer A, Fleßa S (2013) Kostenanalyse der stationär behandelten Clostridium-difficile-assoziierten Diarrhö (CDAD). Gesundh ökon Qual manag 18(2):80–85CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • C. Hübner
    • 1
  • N.-O. Hübner
    • 2
  • K. Hopert
    • 1
  • S. Maletzki
    • 2
  • S. Flessa
    • 1
  1. 1.Institute of Health Care ManagementUniversity of GreifswaldGreifswaldGermany
  2. 2.Institute of Hygiene and Environmental HealthUniversity Medicine of GreifswaldGreifswaldGermany

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