Economics and preventing hospital-acquired infection: broadening the perspective.

OBJECTIVE To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs. DESIGN 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. SETTING Hypothetical modeling to incorporate the societal perspective. SUBJECTS A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement. INTERVENTION(S) 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.