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Infection Risk and Cost-Effectiveness of Commercial Bags or Glass Bottles for Total Parenteral Nutrition

Published online by Cambridge University Press:  02 January 2015

Isabelle Durand-Zaleski ,
Laurent Delaunay ,
Olivier Langeron ,
Eric Belda ,
Alain Astier  and
Christian Brun-Buisson
Isabelle Durand-Zaleski*
Affiliation:
Departments of Public Health, Hôpital Henri Mondor, Créteil, France
Laurent Delaunay
Affiliation:
Surgical Intensive-Care Unit, Hôpital Henri Mondor, Créteil, France
Olivier Langeron
Affiliation:
Medical Intensive-Care Unit and Infection Control, Hôpital Henri Mondor, Créteil, France
Eric Belda
Affiliation:
Gastroenterology, Hôpital Henri Mondor, Créteil, France
Alain Astier
Affiliation:
Hospital Pharmacy, Hôpital Henri Mondor, Créteil, France
Christian Brun-Buisson
Affiliation:
Medical Intensive-Care Unit and Infection Control, Hôpital Henri Mondor, Créteil, France
*
Department of Public Health, Hôpital Henri Mondor, 51, Ave Maréchal de Lattre de Tassigny, 94010, Créteil, France
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Abstract

Objective:

To determine whether the greater daily expense of administering total parenteral nutrition (TPN) via plastic bags changed once daily, compared to glass bottles changed thrice daily, could be offset by savings from a reduction in nosocomial infections.

Design:

The costs and potential benefits of commercially available TPN bags and TPN in glass containers were compared. Costs were computed from the viewpoint of the hospital, first in a general model and then for two specific examples, Crohn's disease and intensive-care unit (ICU) patients. The extra cost of using bags was $20 per day. The total cost of nosocomial bacteremia was estimated at $6,000. The monetary benefits of using TPN bags were $6,000XT, where XT was the percentage of nosocomial infections averted. We also considered that reduction in intravenous (IV)-line manipulation could reduce bacteremia-related mortality and computed a cost-per-life-saved ratio.

Results:

Modeling showed that TPN in bags could yield a net benefit when the absolute reduction in the daily risk of nosocomial bacteremia reached the threshold value of 0.3%. Such a reduction could not be attained in patients with Crohn's disease, and corresponded to a 50% to 60% reduction of infection rates in ICU patients. Varying the risk of mortality attributable to IV-line-related infection from 1% to 13% resulted in a cost effectiveness of using TPN bags ranging from $90,000 to $7,000 per life saved in ICU, assuming a two-thirds reduction in IV-line infections, and from $180,000 to $14,000 if the infection rate was reduced by one third.

Conclusion:

The baseline cost-minimization analysis concluded that the extra cost of TPN bags was not justified by the extra savings. The cost-effectiveness analysis, however, found that the cost per life saved fell within the accepted range of public health interventions, provided a large fraction of infections are averted using TPN bags.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 3 , March 1997 , pp. 183 - 188
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Armstrong, CW, Mayhall, CG, Miller, KB. Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters. J Infect Dis 1986;154:808–816.Google Scholar
2. Snydman, DR, Murray, SA, Kornfeld, SJ, Majka, JA, Ellis, CA. Total parenteral nutrition-related infection. Prospective epidemiological study using semi-quantitative methods. Am J Med 1982;73:695–699.Google Scholar
3. Raad, II, Bodey, G. Infectious complications of indwelling vascular catheters. Clin Infect Dis 1992;15:197–210.CrossRefGoogle ScholarPubMed
4. Drummond, M, Stoddart, G, Torrance, G. Methods for Economic Evaluation of Health Care Programmes. Oxford, England: Oxford University Press; 1989:18-34, 74–83.Google Scholar
5. Office Canadien de Coordination de l'Evaluation des Technologies de la Santé, Ottawa, Ontario, Canada. Lignes directrices pour l'évaluation économique des produits pharmaceutiques; 1994.Google Scholar
6. Robinson, R. Economic evaluation and health care: what does it mean? BMJ 1993;307:670–673.CrossRefGoogle ScholarPubMed
7. Robinson, R. Costs and cost-minimization analysis. BMJ 1993;307:726–728.CrossRefGoogle Scholar
8. Robinson, R. Cost-effectiveness analysis. BMJ 1993;307:793–795.Google Scholar
9. Howard, L, Claunch, C, MC Dowell, R, Timchalk, M. Five years of experience in patients receiving home nutritional support with the implanted reservoir: a comparison with the external catheter. JPEN J Parenter Enteral Nutr 1989;13:478–483.CrossRefGoogle ScholarPubMed
10. Hulliger, S, Pittet, D. Incidence, morbidité et mortalité des infections dues aux cathéters veineux centraux en réanimation. Réan Urg 1994;3:365–369.CrossRefGoogle Scholar
11. Pittet, D, Tatara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs and attributable mortality. JAMA 1994;217:1598–1601.CrossRefGoogle Scholar
12. Daschner, F. Nosocomial infections in intensive care units. Intensive Care Med 1985;11:284–287.Google Scholar
13. Daschner, F. The cost of hospital-acquired infection. J Hosp Infect 1984;5S:27–33.CrossRefGoogle Scholar
14. Arnow, P, Quimosing, E, Beach, M. Consequences of intravascular catheter sepsis. Clin Infect Dis 1993;16:778–784.CrossRefGoogle ScholarPubMed
15. Martone, WJ, Jarvis, WR, Culver, DH, Haley, RW. Incidence and nature of endemic and epidemic nosocomial infection. Hospital Infections. 3rd ed. Boston, MA: Little, Brown & Co; 1992.Google Scholar
16. Gaynes, R, Culver, D, Emori, G, et al. The nosocomial infections surveillance system and beyond: plans for the 1990s and beyond. Am J Med 1991;91(suppl 3B):116S–120S.Google Scholar
17. Wakefield, DS, Hems, CM, Massanari, RM, Mori, M, Pfaller, M. The cost of nosocomial infection: relative contribution of laboratory, antibiotic and per diem costs in serious Staphylococcus aureus infections. Am J Infect Control 1988;16:185–192.CrossRefGoogle ScholarPubMed
18. Garo, B, Boles, JM, Renault, A. Evaluation médico-économique du coût de l'infection nosocomiale. Actualités en Réanimation et Urgences. Paris, France: Arnette-Blackwell; 1995.Google Scholar
19. Société de Réanimation de langue française. Utilisation de l'indice de gravité simplifié et du système oméga. Réan Soins Intens Urg 1986;2:219–221.Google Scholar
20. Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, JE Jr. Extra charges and prolongation of stay attributable to nosocomial infections; a prospective interhospital comparison. Am J Med 1981;70:51–58.CrossRefGoogle ScholarPubMed
21. Weinstein, M. Principles of cost-effective resource allocation in health care organizations. Int J Technol Assessment Health Care 1990;6:93–106.Google Scholar
22. Veluchamy, S, Saver, C. Clinical technology assessment, costeffective adoption and quality management by hospitals in the 1990s. Qual Rev Bull 1990;16:223–228.Google Scholar
23. Drummond, M. Cost-effectiveness guidelines for the reimbursement of pharmaceuticals: is economic evaluation ready or its enhanced status? Health Econ 1992;1:85–92.CrossRefGoogle ScholarPubMed
24. Torrance, G, Feeny, D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989;5:559–575.Google Scholar
25. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed
26. Dixon, R. Effect of infections on hospital care. Ann Intern Med 1978;89:749–753.CrossRefGoogle ScholarPubMed
27. Steinberg, E, Graziano, S. Integrating technology assessment and medical practice evaluation into hospital operation. Qual Rev Bull 1990;16:218–222.Google Scholar
28. Steiner, D, Norman, G. Health Measurement Scales. Oxford, England: Oxford University Press; 1993.Google Scholar