Economic Burden of Intensive Care-Acquired Bacteremia

Author(s):
Timothy Buchman; Felix Chang; Allan Kirk; Eric Elster

Background:

Bacteremia or blood stream infection is a well-known postoperative complication, particularly among patients who require intensive care treatment. However, the total economic burden of bacteremia in the intensive care unit (ICU) is poorly understood. Most inquiries into blood stream infections have dealt with only those connected to the administration of a central line.

Hypothesis:

Estimating the total economic burden of ICA bacteremia is important to provide a foundation for research, advocacy, and education efforts, given the growing adoption of value-based medical practices.

Methods:

This analysis combined data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) with a meta-analysis of data gathered from a literature review of the PubMed database, covering January 1, 2012 through December 31, 2017. Using data associated with ICU services from HCUP, we estimated the annual number of ICU stays in the United States. Since the most recent HCUP data available to us was collected in 2011, we updated our estimate to 2017 based on U.S. Census information. We then used ratios developed from our meta-analysis of clinical studies to determine the number of ICU-acquired bacteremia cases within our estimated ICU population.

Regarding our cost assessment, we focused our literature review on studies that identified the attributable treatment costs for bacteremia, in terms of hospital charges. Since the studies we ultimately selected collected their data in 2010 and 2012, we used the U.S. Federal Reserve’s consumer price index for medical care to update their cost figures to 2017 dollars.

Results:

We estimate that 92,365 patients developed ICU-acquired bacteremia in the United States in 2017. Each of those patients incurred attributable treatment costs that ranged between $39,681 and $52,261. Thus, we nationally assess the total economic burden of ICU-acquired bacteremia to be between $3.7 and $4.8 billion.

Conclusions:

ICU-acquired bacteremia imposes a substantial economic burden on the U.S. healthcare system. Early detection of bacteremia among intensive-care patients and the application of appropriate prophylactic interventions can yield not only improved patient outcomes, but also economic benefits.