The Impact of Healthcare‐Associated Methicillin‐Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems

• Published in: Health services research 2018-12, Vol.53 (6), p.5419-5437
• Main Authors: Nelson, Richard E., Jones, Makoto, Liu, Chuan‐Fen, Samore, Matthew H., Evans, Martin E., Stevens, Vanessa W., Reese, Thomas, Rubin, Michael A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis; Care and treatment; Cohort analysis; Cohort Studies; Costs; Cross Infection - economics; Drug resistance; Federal agencies; Female; Government programs; Health care costs; Health care expenditures; Health care policy; Health Expenditures - statistics & numerical data; Health Resources - economics; Health services utilization; Health status; healthcare utilization and cost; healthcare‐associated infection; Help seeking behavior; Hospitalization; Humans; Infections; Linking VA and Non‐VA Data to Address US Veteran Health Services Issues; Male; Medical care, Cost of; Medicare; Medicare - economics; Methicillin; Methicillin-Resistant Staphylococcus aureus; Middle Aged; MRSA; Nosocomial infections; Patient Acceptance of Health Care - statistics & numerical data; Patient Discharge - economics; Payments; Socioeconomic Factors; Special Issue: Linking VA and Non‐VA Data to Address US Veteran Health Services Issues; Staphylococcal Infections - economics; Staphylococcus aureus; Staphylococcus infections; United States; United States Department of Veterans Affairs - economics; Utilization; Veterans
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.13063

Objective To measure how much of the postdischarge cost and utilization attributable to methicillin‐resistant Staphylococcus aureus (MRSA) health care‐associated infections (HAIs) occur within the US Department of Veterans Affairs (VA) system and how much occurs outside. Data Sources/Study Setting Health care encounters from 3 different settings and payment models: (1) within the VA; (2) outside the VA but paid for by the VA (purchased care); and (3) outside the VA and paid for by Medicare. Study Design Historical cohort study using data from admissions to VA hospitals between 2007 and 2012. Methods We assessed the impact of a positive MRSA test result on costs and utilization during the 365 days following discharge using inverse probability of treatment weights to balance covariates. Principal Findings Among a cohort of 152,687 hospitalized Veterans, a positive MRSA test result was associated with an overall increase of 6.6 (95 percent CI: 5.7–7.5) inpatient days and $9,237 (95 percent CI: $8,211–$10,262) during the postdischarge period. VA inpatient admissions, Medicare reimbursements, and purchased care payments accounted for 60.6 percent, 22.5 percent, and 16.9 percent of these inpatient costs. Conclusions While most of the excess postdischarge health care costs associated with MRSA HAIs occurred in the VA, non‐VA costs make up an important subset of the overall burden.