Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay

Background: Competing resource demands have resulted in the de-escalation of vancomycin-resistant enterococcus (VRE) control programmes in some Canadian healthcare centres.

Aim: To determine the attributable costs and length of stay (LOS) of VRE colonizations/infections in an acute care hospital in Canada.

Methods: Surveillance and financial hospital-based databases were used to conduct analyses with cases and controls from fiscal year 2008-2009 (1 April 2008 to 31 March 2009) at an acute care hospital in downtown Vancouver, Canada. A statistical analysis of attributable costs and LOS was conducted using a generalized linear model. In a secondary analysis, differences in costs and LOS were examined for VRE infections versus colonizations.

Findings: A total of 217 patients with VRE and a random sample of 1075 patients without VRE were examined. VRE has a positive and significant impact on patient hospitalization costs and LOS. Overall, the presence of VRE increased the estimated mean cost per patient by 61.9% (95% confidence interval: 42.3-84.3) in relative terms and $17,949 (13,949-21,464) in absolute Canadian dollars. For LOS, the attributable number of days associated with a VRE case mean was 68.0% (41.9-98.9) higher in relative terms and 13.8 days (10.0-16.9) in absolute days. In the secondary analysis comparing VRE infection and colonization costs, no statistically significant difference was found.

Conclusions: Based on this analysis, the attributable cost and LOS of VRE are considerable. These factors should be considered before de-escalation of a hospital VRE control programme.