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Economics and Preventing Hospital-Acquired Infection: Broadening the Perspective

  • Nicholas Graves (a1) (a2), Kate Halton (a1) (a2) and David Lairson (a3)

To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs.


We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years.


Hypothetical modeling to incorporate the societal perspective.


A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement.


A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement.

Results and Conclusions.

We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade—off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources.

Corresponding author
School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia (
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1.Maynard A. Is it worthwhile reducing hospital infection rates? In Williams JD and Taylor EW, eds. Infection in Surgical Practice. Oxford, England: Oxford University Press; 1992:119122.
2.Graves N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561566.
3.Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996;313:275283.
4.Plowman RP, Graves N, Roberts JA. Hospital Acquired Infection. London: Office of Health Economics; 1997.
5.Drummond MF, Davies LF. Evaluation of the costs and benefits of reducing hospital infection. J Hosp Infect 1991;18 (Suppl 18):8593.
6.Cohen DR. Economic issues in infection control. J Hosp Infect 1984;5 (Supplement A):1725.
7.Haley RW. Cost-Benefit analysis of infection control activities. In Brachman P and Bennett J, eds. Hospital Infections. Philadelphia: Lippincott-Raven; 1998:249267.
8.Plowman RP, Graves N, Griffin MAS, et al. The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. J Hosp Infect 2001;47:198209.
9.Plowman R, Graves N, Griffin M, et al. The Socio-Economie Burden of Hospital Acquired Infection. London:Public Health Laboratory Service; 2000.
10.Schulpher M. The role and estimation of productivity costs in economic valuation. In: Drummond M, McGuire A, eds. Economic Evaluation in Health Care, Merging Theory With Practice. Oxford, England: Oxford University Press; 2000:94112.
11.Robinson R. Cost-utility analysis. BMJ 1993;307:859–62.
12.Williams ASO. Economics of coronary artery bypass grafting. BMJ 1985;291:3269.
13.Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Econ 1986;5:130.
14.Brazier J, Deverill M, Green C, Harper R, Booth A. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999;3:1164.
15.Cookson R. Willingness to pay methods in health care: a sceptical view. Health Econ 2003;12:891894.
16.Saint S, Chenoweth C, Fendrick M. The role of economic evaluation in infection control. Am J Infect Control 2001;29:338344.
17.Gold MR, Siegel JE, Russell LN, Weinstein MC. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
18.Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes. 2nd ed. Oxford, England: Oxford University Press; 1997.
19.Drummond MF, McGuire A. Economic Evaluation in Health Care: Merging Theory With Practice. Oxford, England: Oxford University Press; 2001.
20.Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9:196203.
21.Briggs AH. Handling uncertainty in economic evaluation and presenting the Results. In: Drummond M, McGuire A, eds. Economic Evaluation in Health Care, Merging Theory With Practice. Oxford, England: Oxford University Press; 2001:172241.
22.Donaldson C, Currie G, Mitton C. Cost effectiveness analysis in health care: contraindications. BMJ 2002;325:891894.
23.Evans C, Tavakoli M, Crawford B. Use of quality adjusted life years and life years gained as benchmarks in economic evaluations: a critical appraisal. Health Care Manag Sri 2004;7:4349.
24.Garber AM, Phelps CE. Economic foundations of cost-effectiveness analysis. J Health Econ 1997;16:131.
25.Barry HC, Ebell MH, Hickner J. Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Farn Pract 1997;44:4960.
26.Jacobson JJ, Schweitzer SO, Kowalski CJ. Chemoprophylaxis of prosthetic joint patients during dental treatment: a decision-utility analysis. Oral Surg 1991;72:167–77.
27.Tsevat J, Durand-Zaleski I, Pauker SG. Cost-effectiveness of antibiotic prophylaxis for dental procedures in patients with artificial joints. Am J Public Health 1989;79:739–43.
28.Claxton K. The irrelevance of inference: a decision-making approach to the stochastic evaluation of health care technologies. J Health Econ 1999;18:341364.
29.Cooper NJ, Sutton AJ, Abrams KR, Turner D, Wailoo A. Comprehensive decision analytical modelling in economic evaluation: a Bayesian approach. Health Econ 2004;13:203226.
30.Fenwick E. Cost-effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ 2004;13:405415.
31.Cooper BS, Medley GF, Scott GM. Preliminary analysis of the transmission dynamics of nosocomial infections: stochastic and management effects. J Hosp Infect 1999;43:131–47.
32.Cooper BS, Lipsitch M. The analysis of hospital infection data using hidden Markov models. Biostatistics 2004;5:223–37.
33.Cooper BS, Medley GF, Stone SP, et al. Methicillin-resistant Staphylococcus aureus in hospitals and the community: stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 2004;101:102238.
34.Stone WP, Larson E, Kawar LN. A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. Am J Infect Control 2002;30:145–52.
35.Everett WD, Kipp H. Epidemiologic observations of operating room infections resulting from variations in ventilation and temperature. Am J Infect Control 1991;19:277–82.
36.Chaudhuri AK. Infection control in hospitals: has its quality-enhancing and cost-effective role been appreciated? J Hosp Infect 1993;25:16.
37.Fleming CA, Balaguera HU, Craven DE. Risk factors for nosocomial pneumonia: focus on prophylaxis. Med Clin North Am 2001;85:1545–63.
38.Mehtar S. The continuing problem of ‘hospital staphylococci’: why? J Chemother 1994;6(Suppl 4):2531.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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