Rijt, A.M. (Ties) (2017) Cost-analysis of outbreaks with multi-resistant microorganisms and viruses in Dutch nursing and residential homes. thesis, Medicine.
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Abstract
Objectives Multi-resistant microorganisms are spreading over the world and are becoming increasingly less susceptible for antibiotics. To emphasize the cost effectiveness of infection prevention measures in long-term care, an overview of the costs of an outbreak is required first. This study identifies the costs associated with multiple outbreaks caused by multi-resistant microorganisms or viruses in Dutch long-term care institutions. Methods This retrospective cohort study was performed in Dutch long-term care institutions. The study consists out of two parts. The first part is the personal survey, where institutions were interviewed and the costs for each outbreak were calculated. After an outbreak with Methicillin-resistant Staphylococcus aureus (MRSA), institutions can submit a reimbursement form at the Dutch Healthcare Authority (NZa) and get a part of the total costs reimbursed. These reimbursement forms have been analyzed in the second part of this study. The outbreaks with MRSA included in the personal survey are compared with the reimbursement forms submitted at the NZa. Furthermore, bacterial and viral outbreaks are compared to study if there are any differences in costs. Results A total of seven outbreaks were included in the personal survey. These outbreaks consisted out of five outbreaks with MRSA, one outbreak with colistin-resistant carbapenemase-producing Klebsiella pneumoniae and one outbreak with the Norovirus. The NZa-data consisted out of 46 reimbursement forms, from which 34 forms were complete and have been included. The median of the cost for an outbreak with a multi-resistant microorganism based on the data from the personal survey, is €109.87 and lies between €14.12 and €547.27. Based on the NZa-data this median is €83.80 and lies between €16.89 and €1,820.09. Although we found a difference between the five paired outbreaks in the personal survey and the NZa-data, a Will-Coxon Rank Sum test showed that it is not significant (p=0.068). Also, the Mann-Whitney U test, comparing the viral outbreak with the bacterial outbreaks, turned out not significant (p=0.571). Conclusions This research gives an overview of the total costs associated with outbreaks in long-term care institutions. Costs of an outbreak with a multi-resistant microorganism or virus in these institutions are not directly comparable with the costs of outbreaks in a hospital setting, due to different characteristics. Overall the total costs per patient per day seem lower, although the total costs are much higher, which is caused by the increased duration and number of patients in comparison with outbreaks in a hospital setting.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Friedrich, prof. dr. Alex and Second supervisor: and Lokate, dr. Mariëtte and Third supervisor: and Dik dr. Jan-Willem Department of Medical Microbiology |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1638 |
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