Measuring the Cost Effectiveness of an HAI Reduction Intervention

Hospital decision makers face many complex challenges. Most of their decisions are not the result of an issue having clear-cut solutions or a straightforward path to arriving at those decisions. As with most things in life, there is a lot of gray area. One of the biggest decisions that administrators have to make is what kind of healthcare infection prevention strategy they are going to employ in their facilities.

It can feel like an overwhelming question with no rational answers. The job of making it usually falls to a team of administrators, infection prevention specialists, finance department members, and representatives of the potential intervention. This group collects and analyzes data to determine two interacting factors: the effectiveness of the intervention in reducing infections, and its cost relative to that effect.

In other words, can the facility afford the intervention that is most effective for its patient population and environment? This leads to a discussion of the cost effectiveness of the healthcare-associated infection intervention, which follows here.

Cost Effective vs. Cost Saving

Even though the two terms are often used interchangeably, they are not actually the same thing. Cost saving means that the intervention or product reduces costs; it saves you money. Cost effective, however, means that it is a good value for its price, even though it might not necessarily save you money.

But you are getting a highly effective product or service for the amount of money you are spending, so you could look at it as potentially saving you money in the long run, in terms of the related costs it might save you by not needing to spend on them.

For example, if a hospital decides not to employ an HAI intervention, it would then have to spend (potentially much more) money on additional healthcare treatments for the patients who contract infections while hospitalized. On top of the primary reason the patient went into the hospital, they are now incurring additional costs for treatment for secondary illnesses.

As you can see, “cost effective” could include the possibility of being cost saving as well, but “cost saving” merely refers to the reduction in cost, not the quality or effectiveness of the service or treatment. A service such as an infection prevention program can save you money but not be very effective at controlling the spread of infections, whereas a cost-effective one is likely a good quality service that may or may not reduce overall costs.

So it would seem that when considering an HAI intervention, decision makers’ best bet would be to aim for a cost-effective one. Saving the hospital money doesn’t do a whole lot of good if the intervention isn’t working to keep its patient and employee population protected from infections being passed around.

Effective Is Half the Equation

Cost is obviously easier to measure, and determining how much can be cut or saved is perhaps more straightforward than measuring the effectiveness of the intervention. That part of the “cost-effective” equation falls to a select group of people: scientists, infection specialists, and representatives of the intervention.

These are the people who are working with the treatment and seeing the results. They can provide the data on the effectiveness of the intervention relative to its costs. As such, they are an important voice in the decision-making process. And the only way to be certain that an intervention has value is to select ones that have been tested and documented in peer-reviewed clinical studies that back up their claims of effectiveness.

Hospital administrators need to spend their organization’s finite funds on an intervention that is going to improve patient outcomes. Peer-reviewed journals will validate or discredit the effectiveness of an intervention, giving decision makers some direction on the best value for their money.

Perspective Matters

By the same token, improvement in patient outcomes is definitely a major consideration in selecting an HAI intervention, but it will be more important to some people in the decision-making group than others. Obviously doctors and other caretakers will place greater emphasis on this aspect of the intervention whereas finance administrators, who are responsible for keeping the facility operating within budget, will be paying more attention to the cost (or cost relative to effectiveness of the intervention).

Even the patient will assume some of this financial burden, if not directly by how much they pay for treatment at the facility, then indirectly by time spent out of work if an extended stay due to infection keeps them in the hospital or by emotional costs from pain and discomfort.

And finally, the actual payers of the intervention — the insurance companies and the government medical providers through Medicaid/Medicare — have a substantial role in determining the cost effectiveness of these interventions. Of course they want funds spent on something effective, but they also bear costs if funds are not spent on interventions — increased patient hospitalizations, longer stays, more and varied treatments and supplies and staff.

These costs can be greater than if the intervention, though somewhat pricey, is purchased and utilized. So in the long run, taking on the cost of an intervention that yields effective results may ease financial burden for all affected parties further down the road.

As such, the most accepted approach in measuring the cost effectiveness of HAI intervention is to take a broad, societal perspective: one that considers all parties involved and what they stand to gain or lose. The narrower the perspective, the more bias that will filter that perspective (for example, considering only from the perspective of the hospital’s bottom line). In such a major and complex decision, a balanced approach that incorporates some of everyone’s stakes in the matter yields the most accurate and informative answer to the cost effectiveness of the proposed intervention.