Methods: We created a net present value model based upon the projected effectiveness and cost of a national, multifaceted Clostridium difficle infection (CDI) prevention program as described by Slayton et al. (Infect Control Hosp Epidemiol 2015;36(6):681-7). Slayton et al. focused on the cost benefit among Medicare recipients. Our model expanded on those findings by projecting net benefit of the intervention program among all patients. Additional model inputs for incidence rates, mortality rates, and attributable patient cost savings were taken from recent studies on CDI by Lessa et al. (N Engl J Med 2015;372:825) and Kwon et al. (Infect Dis Clin North Am 2015;29(1):123-34). The model used a 5 year time horizon (2015-2019), a 3% discount rate, and a one year lag before benefits start. Projections for national population and hospital discharges are from the United States (U.S.) Census Bureau and the Healthcare Cost Utilization Project. Value of statistical life (VSL) estimates for mortality risk reductions are taken from current U.S. Department of Transportation guidelines (lower bound $5.3 million, upper bound $13.3 million).
Over 5 years, the national intervention is projected to avert 780,541 CDI cases and 30,805 deaths. Without considering VSL, the net benefit of the intervention is $1.8 billion ($6.1 billion in direct medical cost savings minus $4.3 billion in intervention costs). When VSL is included in the analysis, net benefits from the intervention ranges from $170.8-$423.8 billion.
Conclusion: Accounting for the economic value of mortality risk reductions, a technique that typically has not been included in CBA studies of HAI, will have a major impact on any economic evaluations of HAI interventions and substantially increase the magnitude of prevention benefits.
R. Scott II,
J. Baggs, None
J. Jernigan, None