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The European Journal of Health Economics

, Volume 10, Issue 3, pp 287–297 | Cite as

The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals

Original Paper

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant problem in many healthcare systems. In Germany, few data are available on its economic consequences and, so far, no study has been performed using a large sample of real-life data from several hospitals. We present a retrospective matched-pairs analysis of mortality, length of stay, and cost of MRSA patients based mainly on routine administrative data from 11 German hospitals. Our results show that MRSA patients stay in hospital 11 days longer, exhibit 7% higher mortality, are 7% more likely to undergo mechanical ventilation, and cause significantly higher total costs (€ 8,198).

Keywords

Cost analysis Length of stay Mortality MRSA Outcome 

JEL Classification

I12 I18 C13 C14 

Notes

Acknowledgement

The research presented in this article was financed by Pfizer Deutschland GmbH.

References

  1. 1.
    Austin, P.C., Mamdani, M.M., Stukel, T.A., Anderson, G.M., Tu, J.V.: The use of the propensity score for estimating treatment effects: administrative versus clinical data. Stat. Med. 24, 1563–1578 (2005). doi: 10.1002/sim.2053 CrossRefGoogle Scholar
  2. 2.
    Cochran, W.G.: The effectiveness of adjustment by subclassification in removing bias in observational studies. Biometrics 24, 295–313 (1968). doi: 10.2307/2528036 CrossRefGoogle Scholar
  3. 3.
    Coia, J.E.: Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J. Hosp. Infect. 63(Suppl 1), S1–S44 (2006)CrossRefGoogle Scholar
  4. 4.
    Cosgrove, S.E., Carmeli, Y.: The impact of antimicrobial resistance on health and economic outcomes. Clin. Infect. Dis. 36, 1433–1437 (2003). doi: 10.1086/375081 CrossRefGoogle Scholar
  5. 5.
    Deutsche Krankenhausgesellschaft (DKG): Spitzenverbände der Krankenkassen (GKV), Verband der privaten Krankenversicherung (PKV), Institut für das Entgeltsystem im Krankenhaus (InEK gGmbH): Deutsche Kodierrichtlinien: Allgemeine und Spezielle Kodierrichtlinien für die Verschlüsselung von Krankheiten und Prozeduren. Version 2004. Institut für das Entgeltsystem im Krankenhaus, Siegburg (2003)Google Scholar
  6. 6.
    Deutsche Krankenhausgesellschaft (DKG), Spitzenverbände der Krankenkassen (GKV), Verband der privaten Krankenversicherung (PKV): KALKULATION VON FALLKOSTEN: Handbuch zur Anwendung in Krankenhäusern. Version 2.0 (2002)Google Scholar
  7. 7.
    European Antimicrobial Resistance Surveillance System (EARSS): EARSS Annual Report 2006, Bilthoven, (2007)Google Scholar
  8. 8.
    Gastmeier, P., Daschner, F., Rüden, H.: Surveillance von nosokomialen Infektionen mit dem Krankenhaus-Infektions-Surveillance-System (KISS) lohnt sich. Krankenhaus 97, 119–122 (2005)Google Scholar
  9. 9.
    Gastmeier, P., Sohr, D., Geffers, C., Behnke, H., Daschner, F., Rüden, H.: Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: results from the German nosocomial infection surveillance system (KISS). Infection 33, 50–55 (2005). doi: 10.1007/s15010-005-3186-5 CrossRefGoogle Scholar
  10. 10.
    Geldner, G., Ruoff, M., Hoffmann, H.-J., Kiefer, P., Georgieff, M., Wiedeck, H.: Eine Kostenanalyse von MRSA-Infektionen auf einer operativen Intensivstation. Anasthesiol. Intensivmed. Notfallmed. Schmerzther. 34, 409–413 (1999). doi: 10.1055/s-1999-10830 CrossRefGoogle Scholar
  11. 11.
    Gould, I.M.: The clinical significance of methillicin-resistant Staphylococcus aureus. J. Hosp. Infect. 61, 277–282 (2005). doi: 10.1016/j.jhin.2005.06.014 CrossRefGoogle Scholar
  12. 12.
    Greiner, W., Rasch, A., Köhler, D., Salzberger, B., Fätkenheuer, G., Leidig, M.: Clinical outcome and costs of nosocomial and community-acquired Staphylococcus aureus bloodstream infection in haemodialysis patients. Clin. Microbiol. Infect. 13, 264–268 (2007). doi: 10.1111/j.1469-0691.2006.01622.x CrossRefGoogle Scholar
  13. 13.
    Herr, C.E., Heckrodt, T.H., Hofmann, F.A., Schnettler, R., Eikmann, T.F.: Additional cost for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these cost on a surgical ward. Infect. Control Hosp. Epidemiol. 24, 673–678 (2003). doi: 10.1086/502274 CrossRefGoogle Scholar
  14. 14.
    Ho, D., Imai, K., King, G., Stuart, E.: Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Polit. Anal. 15, 199–236 (2007). doi: 10.1093/pan/mpl013 CrossRefGoogle Scholar
  15. 15.
    Kreienbrock, L., Schach, S.: Epidemiologische Methoden, 4th edn. Spektrum, Heidelberg (2005)Google Scholar
  16. 16.
    Lemmen, S.W., Zolldann, D., Häfner, H., Lütticken, R., Koch, S.: Einfluss der klinischen Infektiologie. Nicht nur multiresistente Erreger sondern auch die Kosten in Schach halten. Klinikarzt 33, 21–24 (2004). doi: 10.1055/s-2004-819024 CrossRefGoogle Scholar
  17. 17.
    Nationales Referenzzentrum für Surveilance von Nosokomialen Infektionen (NRZ): KISS Krankenhaus-Infektions-Surveillance-System, Modul: MRSA-KISS 2004, Abschnitt A.1—Referenzdaten Gesamt (2005)Google Scholar
  18. 18.
    Nathwani, D.: Impact of methicillin-resistant Staphylococcus aureus infections on key health economic outcomes: does reducing the length of hospital stay matter? J. Antimicrob. Chemother. 51(Suppl S2), ii37–ii44 (2003)Google Scholar
  19. 19.
    Noskin, G.A., Rubin, R.J., Schentag, J.J., Kluytmans, J., Hedblom, E.C., Smulders, M., Laptina, E., Gemmen, E.: The burden of Staphylococcus aureus infections on hospitals in the United States. An analysis of the 2000 and 2001 nationwide inpatient sample database. Arch. Intern. Med. 165, 1756–1761 (2005). doi: 10.1001/archinte.165.15.1756 CrossRefGoogle Scholar
  20. 20.
    Regierung der Bundesrepublik Deutschland: Antwort der Bundesregierung auf die Kleine Anfrage der Abgeordneten Frank Spieth, Klaus Ernst, Dr. Martina Bunge, Katja Kipping und der Fraktion DIE LINKE. Drucksache 16/2942—Ausbreitung multiresistenter Keime in deutschen Kliniken und Strategien dagegen. In: Deutscher Bundestag, Bundestagsdrucksache 16/3205, October 30, (2006)Google Scholar
  21. 21.
    Robert Koch Institut (RKI): Merkblätter für Ärzte. Staphylokokken-Erkrankungen, insbesondere Infektionen durch MRSA. Epidemiologisches Bulletin 08/2000, amended and updated, February 2007Google Scholar
  22. 22.
    Rubin, D.B.: Multivariate matching methods that are equal percentage bias reducing, I. Some examples. Biometrics 32, 109–120 (1976)CrossRefGoogle Scholar
  23. 23.
    Stausberg, J., Lehmann, N., Kaczmarek, D., Stein, M.: Einheitliches Kodieren in Deutschland: Wunsch und Wirklichkeit. Krankenhaus 97, 657–662 (2005)Google Scholar
  24. 24.
    Vriens, M., Blok, H., Fluit, A., Troelstra, A., Van Der Werken, C., Verhoef, J.: Cost associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur. J. Clin. Microbiol. Infect. Dis. 21, 782–786 (2002). doi: 10.1007/s10096-002-0811-4 CrossRefGoogle Scholar
  25. 25.
    Wernitz, M.H., Keck, S., Swidsinski, S., Schulz, S., Veit, S.K.: 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, 466–471 (2005). doi: 10.1111/j.1469-0691.2005.01153.x CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Bad DürkheimGermany
  2. 2.Dr. Wilke GmbHMunichGermany
  3. 3.Rambøll Management GmbHBerlinGermany

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