The prevailing notion that a catheter-associated urinary tract infection costs about $1,000 is 'an underestimate and an oversimplification,' say two researchers. Some CAUTIs cost $10,000 or more.
For the past decade, Medicare has declined to reimburse hospitals for catheter-associated urinary tract infections (CAUTI) and other preventable hospital-acquired conditions.
The goal has been to create a financial incentive for hospitals to take infection prevention steps. But, without a clear sense for how much CAUTIs cost, hospitals may not be responding appropriately to that financial incentive, according to research published online Thursday by the American Journal of Infection Control (AJIC).
Although $1,000 is often cited as the average cost of treating one CAUTI, that figure is likely too low, according to researchers Christopher S. Hollenbeak, PhD, professor of surgery and public health sciences at Pennsylvania State University, and Amber L. Schilling, PharmD, MEd, research analyst at the Penn State College of Medicine.
Hollenbeak and Schilling conducted a systematic review of existing literature in an effort to better understand available cost data. They excluded studies that were based on the marked-up prices providers charged for CAUTI-related goods and services, focusing instead on studies conducted in the United States between 2000 and 2017 with novel patient-level cost data.
These stringent parameters left only four studies for Hollenbeak and Schilling to analyze. Due to differences in design, patient population, and cost perspective, data from the four studies could not be pooled, so the researchers were unable to conduct meta-analysis.
“However, we can conclude that the prevailing notion of a CAUTI costing approximately $1,000 is an underestimate and an oversimplification of its true economic burden,” Hollenbeak and Schilling wrote. “Many factors can increase the attributable cost well above $1,000.”
Costs attributable to a CAUTI, as reported in the four studies, ranged from $876 to $10,197 when inflation-adjusted into the equivalent of 2016 dollars.
The low end of that range came from a study of adult patients in an inpatient setting, with costs calculated from the hospital’s perspective. The high end came from a study of intensive care unit patients, with costs calculated from Medicare’s perspective.
The review suggests that a CAUTI’s cost depends heavily upon the patient’s acuity, the population being served (e.g., adult or pediatric), and the cost perspective (e.g., hospital or Medicare), the researchers wrote, noting that more research is needed.
Even with these rough numbers, however, there is reason to believe CAUTIs could be costing the U.S. much more than previously thought, Hollenbeak and Schilling wrote.
The Centers for Disease Control and Prevention’s National Healthcare Safety Network estimated in 2009 that CAUTIs place a total economic burden of $340 million annually in the U.S., but the AJIC study suggests the number is closer to five-times that amount, at $1.7 billion.
Steven Porter is editor at HealthLeaders.