Major Article
Systematic review of economic analyses of health care-associated infections

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Background

Economic evidence is needed to assess the burden of health care-associated infections (HAIs) and cost-effectiveness of interventions aimed at reducing related morbidity and mortality. The objective of this study was conducted to assess the quality of economic evaluations related to HAI and synthesize the evidence.

Methods

A systematic review of research published between January 2001 and June 2004 was conducted. Quality of the publication was estimated using a Likert-type scale. All cost estimates were standardized into a common currency. Descriptive statistics and a logistic regression were conducted to identify predictors of high quality.

Results

70 studies were audited. There was wide variation in these cost estimates. Publications estimating the cost attributable to an infection were almost 7 times more likely judged to be of higher quality than studies of the cost of interventions (P < .05). Papers in which the authors stated the perspective (hospital or societal) were twice as likely to be judged as being of high quality (P < .05).

Conclusion

There are more publications and growing interest in estimating the costs of HAI. However, the methods employed vary. We recommend (1) the use of guidelines for authors and editors on conducting an economic analysis, (2) development of more sophisticated mathematical models, and (3) training of infection control professionals in economic methods.

Section snippets

Methods

A systematic review of existing published evidence was conducted. Articles were included if they were published between January 2001 and June 2004, had an abstract for review, contained an original cost estimate, and were written in English. To find the published analyses, searches were conducted in MEDLINE, EconoLit, and HealthSTAR using the medical subject headings (MeSH) or text keywords “nosocomial infections,” “infection control,” or “hospital acquired infections” cross referenced with

Results

One hundred fifty-two manuscripts were obtained for review. Of these, 70 studies met our eligibility criteria. See Appendix A for full list of the eligible articles. Table 1 summarizes publications in terms of country of study, funding source, description of HAI analyzed, and economic methods employed.

The majority of the analyses were conducted in the United States. Although the most commonly reported funding source for these studies was government or industry, many authors did not report

Discussion

We have found substantial growth in published evidence estimating the cost of HAI and interventions aimed at decreasing the related morbidity and mortality. In our previous audit using the same inclusion criteria, there were only 55 eligible articles found over a 10-year period compared with the 70 publications we found over a two-and-half-year period.8 However, as in the previous audit, the majority of the articles were simple cost analyses conducted from the hospital rather than the societal

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    Supported by an unrestricted grant from the Association of Professionals in Infection Control and Epidemiology Research Foundation through a grant from 3M Health Care.

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