Cost-Benefit Analysis Of Surgical Site Infection Prevention In Patients With Craniocerebral Operation

BackgroundIn recent years, Surgical Site Infection(SSI) has attracted extensive attention because it increased length of hospital stay and health care costs, brought suffering to patients and wasted medical resources. Many evidence-based studies indicated that most SSI could be prevented through establishing and maintaining effective infection control programs. At the same time, the programs call for investment. The objective of this study is to investigate the cost-benefit of surgical site infection surveillance and control in medical institutions in order to provide evidence for national policy and hospital decision-making.Methods1. Prospective surveillance of surgical site infection was conducted through July,2009to June,2012. SSI patients and non-SSI patients were matched with a ratio of1:2by the following items:surgery name, type of incision, ASA score, gender, age±5years and surgery date±1year. As a result,38out of85infected patients were successfully matched through the3years. A case control study was conducted using these38SSI patients as the case group and the matched76non-SSI patients as the control group. Terms such as medical costs, length of hospital stay, DDD value of antibiotic consumption and re-operation rate, etc. were compared between the two groups. According to the economic loss of hospital infection causing additional expenditure and patients reduction; we estimated the benefits of hospital infection control.2. To estimate the cost of human resources and materials of hospital infection surveillance and control. These costs included wages of full-time infection staff, part time ward infection control nurse and infection control doctors, utilities and other consumables.3. To calculate the cost benefit rate in different medical context and with different SSI-case ratio.ResultsThe results have shown that length of hospital stay was prolonged by11.75days (95%CI:6.24-22.52), medical costs increased by21314.68Chinese Yuan (95%CI:10497.52-36726.38), and antibiotics consumption increased by14.5DDD value (95%CI:6.88-31.03) with the occurrence of craniocerebral operations infection. As regard to hospital infection caused additional expenditure and patients’reduction, the direct economic loss was717,770Chinese Yuan in a40-bed ward. Thirty four thousand and seven hundred Chinese yuan should be invested to monitor and control SSI. Under current payment system, infection control cannot lead to direct economic benefit, but can yield indirect benefit through reducing use of antibiotics, increasing inpatient quantity, etc. After the total prepayment system is carried out, the savings from a5per cent incidence lower of SSI can totally cover the cost of surveillance and control. When infection rate reduced30per cent, cost benefit ratio can be up to6.21.ConclusionWith the medical insurance system being not perfect, the control of SSI can hardly yield direct economic benefits but social benefit. After implementation of the total prepayment system, SSI control showed a pretty high cost benefit ratio.