Analysis of MRSA-attributed costs of hospitalized patients in Germany
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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.
KeywordsOpportunity Cost Laboratory Cost Hygienic Measure Prolonged Length Isolation Time
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.
- 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
- 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
- 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
- 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
- 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
- 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.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
- 19.Haubrock M (2007) Krankenhausfinanzwirtschaft. In: Haubrock M, Schär W (eds) Betriebswirtschaft und Management im Krankenhaus. Huber, Bern, pp 394–453Google Scholar
- 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