The Michigan Department of Community Health MRSA/CDI Prevention Initiative: A Cost Analysis

BACKGROUND:   Healthcare-associated infections (HAIs) in acute care hospitals and long term care facilities impose significant economic consequences on the healthcare system. HAIs cost U.S. hospitals $35.7 to $45 billion (2007 dollars) annually. We use published results from medical and epidemiological literature to provide a healthcare cost estimate for treating methicillin-resistant Staphylococcus aureus and Clostridium difficile infection (MRSA/CDI) in Michigan. 

METHODS: The Michigan Department of Community Health (MDCH) MRSA/CDI Prevention Initiative consists of 13 acute care hospitals and 12 skilled nursing facilities (SNF). Acute care facilities submit MRSA/CDI Laboratory-identified event data to the CDC National Healthcare Safety Network (NSHN) monthly; skilled nursing facilities submit faxed forms. Data on events occurring between May 2012 and April 2013 was analyzed. Events were categorized according to specimen collection site and the International Classification of Diseases, Ninth Revision (ICD-9) codes: 008.45 Clostridium difficile; 038.12 S. aureus septicemia; 482.42 S. aureus pneumonia and 041.12 Other S. aureus infections.  ICD-9 codes were inputted into the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project database to estimate mean cost from Cost-to-Charge Ratios for the Midwest region (2011). Cases were classified as Healthcare-Onset (HO) and Community-Onset (CO) in accordance to NHSN definitions.

RESULTS:   Acute care facilities incurred $21,025,200 in MRSA-associated costs while skilled nursing facilities incurred $345,500. Acute care facilities incurred costs of $15,277,200 associated with CDI, and skilled nursing facilities $374,100. Other/Unspecified was the most frequently reported MRSA event type for both acute care and skilled nursing, with 44.1% and 97.3% respectively. The majority of acute care MRSA and CDI events were CO, with 36.2% and 43.2% respectively, while the majority of SNF events were HO, 86.4% and 90.7% respectively.  The total combined financial burden of MRSA and CDI among the participating facilities was $37,022,000.

CONCLUSIONS:   Data from this sample of 25 Michigan facilities provides a demonstration of the significant healthcare costs associated with MRSA and CDI. Although the sample size was small, the burden of HAIs is substantial, and prevention of MRSA and CDI among patients would reduce associated healthcare costs. Most HAIs are preventable with effective surveillance and control programs. The cost estimates in this study may be used to support investment in HAI reduction efforts. Infection preventionists should utilize this data to build a business case for prevention and control measures which will ultimately reduce costs to patients, hospitals, and the healthcare system. Most importantly, these actions could lead to a reduction in patient harm.