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Economics and Preventing Healthcare Acquired Infection

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Nicholas Graves
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Reasons for Writing This Book The published literature on the economic appraisal of healthcare acquired infection (HAI) is described by phrases such as: "With so many virtues of the cost-benefit approach identified, it is perhaps puzzling why greater use of economic appraisal has not been made in the area of infection control" [1] "Clinicians should partner with economists and policy analysts to expand and improve the economic evidence available" [2] "the quality of economic evaluations should be increased to inform decision makers and clinicians" [3] "The economics of preventing hospital-acquired infections is most often described in general terms. The underlying concepts and mechanisms are rarely made explicit but should be understood for research and policy-making" [4] The aim of this book is to describe how economics should be used to inform decisi- making about infection control. Our motivation stems from the previous quotes which show economics is being used within the infection control community, but not to its full potential. Our expectation is that you do not have any formal training in economic analyses. Economic analyses have been used for many decades to argue for increased funding for hospital infection-control. In 1957, Clarke [5] investigated bed wastage in British hospitals due to Staphylococcus aureus in patient's wounds. She concluded .... "the average length of stay in hospital of patients whose wounds were infected with Staph.
"The evolution of organisms that cause healthcare acquired infections (HAI) puts extra stress on hospitals already struggling with rising costs and demands for greater productivity and cost containment. Infection control can save scarce resources, lives, and possibly a facility's reputation, but statistics and epidemiology are not always sufficient to make the case for the added expense. Economics and Preventing Healthcare Acquired Infection presents a rigorous analytic framework for dealing with this increasingly serious problem.
Engagingly written for the economics non-specialist, and brimming with tables, charts, and case examples, the book lays out the concepts of economic analysis in clear, real-world terms so that infection control professionals or infection preventionists will gain competence in developing analyses of their own, and be confident in the arguments they present to decision-makers. The authors:

Ground the reader in the basic principles and language of economics.

Explain the role of health economists in general and in terms of infection prevention and control.

Introduce the concept of economic appraisal, showing how to frame the problem, evaluate and use data, and account for uncertainty.

Review methods of estimating and interpreting the costs and health benefits of HAI control programs and prevention methods.

Walk the reader through a published economic appraisal of an infection reduction program.

Identify current and emerging applications of economics in infection control.

Economics and Preventing Healthcare Acquired Infection is a unique resource for practitioners and researchers in infection prevention, control and healthcare economics. It offers valuable alternate perspective for professionals in health services research, healthcare epidemiology, healthcare management, and hospital administration."
Acknowledgements.- Introduction.- Chapter 1. Economics.- A broad view of economics .- The building blocks of economics.- The concept of scarcity.- The concept of opportunity cost.- The concept of efficiency.- The concept of competitive markets.- The concept of market failure.- The concept of economic appraisal.- Conclusions.- Chapter 2. Health Economics.- Origins and content of health economics.- The parts of health economics most useful for infection-control.- Competing approaches to economic appraisal.- Welfarism.- Extra-welfarism.- Advantages and Disadvantages of each type of economic appraisal.- Conclusions.- Chapter 3. Economic appraisal: a general framework.- What an economic appraisal looks like.- Incremental Analysis .- Ceiling ratios and choosing health care programs.- Conclusions.- Chapter 4. Economic appraisal: the nuts and bolts.- Using a clinical trial versus a modeling study.- Economic appraisal alongside clinical trials.- Economic appraisal by modeling study.- Building a model .- Objective One - Define the structure of the model.- Objective Two - Find the evidence required to make the decision.- Objective Three - Evaluate the model that has been designed .- Objective Four - Account for heterogeneity & uncertainty.- Objective Five - Value future research .- Important features of an economic appraisal.- Conclusions.- Chapter 5. Changes arising from the adoption of infection control programs.- Overview of the major changes.- Changes to the number of infections.- Epidemiological studies.- Synthesizing existing evidence.- Conclusions.- Chapter 6 - Measuring the cost of Healthcare Acquired Infections.- Why data on the cost of HAI are useful.- Defining and measuring costs of HAI .- The cost accountant's method.- The economist's method.- Differences between the cost accounting and economicsmethods.- Estimating the increase in length of stay due to HAI .- Design approaches.- Statistical approaches.- Conclusions.- Chapter 7. Measuring the cost of implementing infection control programs.- Estimating the costs of Infection Control programs.- Two case studies for estimating the cost of infection control.- A case study of the costs of adopting antimicrobial catheters.- A case study of the costs of a staff education program.- Analyzing costs, inputs and outputs.- Incremental costs.- Average Costs.- Cost data and decision making.- Capital costs.- Conclusions.- Chapter 8. Preventing HAI and the health benefits that result .- Health benefits.- What QALYs are and how they are estimated.- Information required to estimate QALYs.- The risk of death due to infection.- The nature of the health states and the methods for finding utility scores that describe them.- Conclusions.- Chapter 9. Dissecting a published economic appraisal.- Economic evaluation in the infection control literature.- Case study of a decision to adopt antimicrobial central venous catheters.- Structuring the evaluation.- Evidence required for the evaluation.- Epidemiological parameters.- Effectiveness of antimicrobial CVCs.- Costs.- Health outcomes.- Evaluating the decision.- Handling uncertainty in the decision.- Parameter uncertainty.- Data quality.- Generalizability.- Interpreting the results for decision making.- Conclusions.- Chapter 10. Economic facts and the infection control environment.- The changing infection control environment .- The economic facts.- Diminishing returns.- Cost structures.- Lack of good information .- Incentives for bad behavior.- Conclusion.

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