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Study on the Cost Attributable to Central Venous Catheter-Related Cai et al. Health and Quality of Life Outcomes (2018) 16:198 https://doi.org/10.1186/s12955-018-1027-3 RESEARCH Open Access Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China Yuanyi Cai1, Min Zhu1, Wei Sun2, Xiaohong Cao1 and Huazhang Wu1* Abstract Background: Central venous catheters (CVC) have been widely used for patients with severe conditions. However, they increase the risk of catheter-related bloodstream infection (CRBSI), which is associated with high economic burden. Until now, no study has focused on the cost attributable to CRBSI in China, and data on its economic burden are unavailable. The aim of this study was to assess the cost attributable to CRBSI and its influencing factors. Methods: A retrospective matched case-control study and multivariate analysis were conducted in a tertiary hospital, with 94 patients (age ≥ 18 years old) from January 2011 to November 2015. Patients with CRBSI were matched to those without CRBSI by age, principal diagnosis, and history of surgery. The difference in cost between the case group and control group during the hospitalization was calculated as the cost attributable to CRBSI, which included the total cost and five specific cost categories: drug, diagnostic imaging, laboratory testing, health care technical services, and medical material. The relation between the total cost attributable to CRBSI and its influencing factors such as demographic characteristics, diagnosis and treatment, and pathogenic microorganism, was analysed with a general linear model (GLM). Results: The total cost attributable to CRBSI was $3528.6, and the costs of specific categories including drugs, diagnostic imaging, laboratory testing, health care technical services, and medical material, were $2556.4, $112.1, $321.7, $268.7, $276.5, respectively. GLM analysis indicated that the total cost was associated with the intensive care unit (ICU), pathogenic microorganism, age, and catheter number, according to the sequence of standardized estimate (β). ICU contributed the most to the model R-square. Conclusion: Central venous catheter–related bloodstream infection represents a great economic burden for patients. More attentions should be paid to further prevent and control this infection in China. Keywords: Catheter–related bloodstream infection, Cost, Influencing factor Background been carried out worldwide to focus on the cost of CRBSI. Central venous catheters (CVC) have been widely used in According to our knowledge, four designs including a the treatment of patients with severe diseases. However, retrospective matched case-control study [1–3], prospect- the utilization of CVC may cause catheter-related blood- ive research [4–8], multivariate analysis [9], and a case re- stream infection (CRBSI), which is a great economic bur- port [10], have been used to evaluate the cost attributable den on the patients. In recent years, many studies have to CRBSI. The cost of CRBSI has been estimated to be be- tween $11,971and $69,332 in America [1, 4, 5, 9, 10]. Studies performed in European countries have reported * Correspondence: [email protected] the cost to be in the ranges of €13,585 to €29,909 [2, 6]. 1Department of Health Service Management, School of Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North The value calculated in developing countries has ranged New Area, Shenyang, Liaoning Province 110122, People’s Republic of China Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Cai et al. Health and Quality of Life Outcomes (2018) 16:198 Page 2 of 6 between $4888 and $11,591 [7, 8]. A recent Japanese study hospital. All patients (age ≥ 18 years old) with central reported an excess cost of $57,090 for CRBSI [3]. venous catheter-related bloodstream infection in every In China, CRBSI is currently one of the four nosocomial department from January 2011 to November 2015 were infections monitored by the Chinese government [11], included, and there were a total of 94 patients for the and it has aroused increasing public attention. A prospect- case group. Meanwhile, a matched (1:1) case-control ive investigation of CRBSI was conducted across 12 prov- study design was utilized. The controls were defined as inces and showed that the incidence rate was between patients with CVC insertion but without CRBSI. A total 0.69 and 14.22 per 1000 central catheter days (133 out of of three key variables were used in the matching proced- 4256 patients infected by CRBSI in 55 intensive care units ure, including age (± 10 yr.), principal diagnosis, and his- (ICU) from 41 hospitals monitored from October 2013 to tory of surgery [8, 14]. March 2014) [12]. However, there is still no report about the cost attributable to CRBSI in China. The factors influ- Assessment of cost attributable to CRBSI encing this economic burden are also unknown. The The cost data were derived from the patients’ true hospital Chinese government is currently trying to solve the prob- expenditure and were provided by the financial department lem of the high costs of obtaining medical services with of the hospital. The duration from the time of admission of new medical reform. Distinguishing between the cost of the patient to the day of discharge was selected. The costs primary disease and that of CRBSI can help the govern- of patients with CRBSI were analysed and compared with ment to determine the origin of the economic burden and those of the patients without CRBSI. The difference in cost further evaluate the burden from CRBSI itself, which between the two groups during the hospitalization was cal- would be useful to establish targeted control strategies. culated as the cost attributable to CRBSI. This difference in- Furthermore, an analysis of factors that influence the cost cluded the total cost and five specific cost categories: 1) attributable to CRBSI will also provide evidence to hospi- drug, 2) diagnostic imaging, 3) laboratory testing, 4) health tals for improving medical quality and to patients for care technical service, and 5) medical material. The analysis exerting better self-care during hospitalization. ofthedrugincludedonlywesternmedicine.Diagnosticim- The purpose of the present study was to assess the cost aging included the diagnosis of Doppler ultrasonography, attributable to CRBSI and explore its influencing factors electrocardiogram, computed tomography (CT), and other for the government, hospitals and patients. Because the small medical devices. Laboratory testing mainly included a incidence of CRBSI is low in China [12], and the informa- routine blood test, and a bacterial culture. Health care tech- tion in Chinese hospital medical records is not as suffi- nical service included surgery, physical examination, nurs- cient as that in developed countries, methods such as ing, medical disposition, and group consultation. Medical prospective research, multivariate analysis, and case re- material was defined as the medical consumables and equip- ports were not feasible. Thus, this study was a retrospect- ment used in the hospital such as catheters and sutures. ive matched case-control study. The cost attributable to The currency exchange rate used was US$1 to ¥ 6.8977. CRBSI and its influencing factors available in the hospital information system (HIS) and medical records, including Measurements of demographic characteristics, diagnosis demographic characteristics, diagnosis and treatment, and and treatment, and pathogenic microorganism pathogenic microorganisms, were analysed. We believe Demographic characteristics included age, sex, occupa- our findings can help the government, hospitals and pa- tion, and immunosuppressive drug history. Occupation tients to prevent and control this infection. was categorized as worker, farmer, office clerk, retiree, and others according to the information provided by the Methods patients on the front page of the medical record. Definition Diagnosis and treatment was assessed based on 5 items: CRBSI is described as the presence of bacteraemia or 1) ICU, 2) principal diagnosis, 3) other diagnoses, 4) oper- fungemia in patients with a catheter or within 48 h after ation level, and 5) catheter number. If the patients were the catheter removal without the presence of any other admitted to the ICU during the hospital stay, this indi- source of infection. The clinical signs of patients with cated that they had a severe condition and that their treat- CRBSI are fever (> 38 °C), chills, and hypotension. La- ment would cost much more than those of other patients. boratory microbiology examinations have shown a posi- The principal diagnosis was categorized as cancer, inflam- tive result for the peripheral blood sample culture or the mation, and others. Patients with cancer and severe in- catheter tip culture of the same microorganism [13]. flammation made an impact on the treatment of CRBSI. Other diagnoses were marked “yes” if diagnoses such as Study population hypertension and diabetes were found in the patients’ The study was conducted in a tertiary hospital affiliated medical records. The operation level was categorized as with China Medical University. It is a public 3346-bed not performing an operation or performing an operation Cai et al. Health and Quality of Life Outcomes (2018) 16:198 Page 3 of 6 and ranged from level one to level four based on the com- types of operations associated with the primary diseases plexity of the surgery [15], with level four representing the were performed.
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