Impacto económico de las bacteriemias nosocomiales. Comparación de tres metodologías de cálculo

Introduction The excess cost associated with nosocomial bacteraemia (NB) is used as a measurement of the impact of these infections. However, some authors have suggested that traditional methods overestimate the incremental cost due to the presence of various types of bias. The aim of this study was to compare three assessment methods of NB incremental cost to correct biases in previous analyses. Methods Patients who experienced an episode of NB between 2005 and 2007 were compared with patients grouped within the same All Patient Refined-Diagnosis-Related Group (APR-DRG) without NB. The causative organisms were grouped according to the Gram stain, and whether bacteraemia was caused by a single or multiple microorganisms, or by a fungus. Three assessment methods are compared: stratification by disease; econometric multivariate adjustment using a generalised linear model (GLM); and propensity score matching (PSM) was performed to control for biases in the econometric model. Results The analysis included 640 admissions with NB and 28,459 without NB. The observed mean cost was € 24,515 for admissions with NB and € 4,851.6 for controls (without NB). Mean incremental cost was estimated at € 14,735 in stratified analysis. Gram positive microorganism had the lowest mean incremental cost, € 10,051. In the GLM, mean incremental cost was estimated as € 20,922, and adjusting with PSM, the mean incremental cost was € 11,916. The three estimates showed important differences between groups of microorganisms. Conclusions Using enhanced methodologies improves the adjustment in this type of study and increases the value of the results.