The direct medical economic burden of healthcare-associated infections and antimicrobial resistance: A preliminary study in a teaching hospital of Nepal

Abstract

ABSTRACT: Objectives: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) have posed major challenges to South Asia. The purpose of this study is to explore the direct medical economic burden attributable to HAIs and AMR in Nepal. Methods: A prospective study was conducted in a teaching hospital of Nepal from 16 December 2017 to 16 April 2018. The demographic, clinical, and financial expense data were extracted from medical records, laboratory reports, and hospital information system. STATA 12.0 was used to conduct descriptive analysis, χ2 test, t test, and propensity score matching. Results: The prevalence of HAIs was 3.31% in the hospital. The additional total medical expenses, medicine expenses, out-of-pocket expenses, and hospitalisation days per inpatient attributable to HAIs were $164.63, $114.96, $150.79, and 7 days, respectively. In contrast, the additional direct medical economic burden attributable to HAIs-AMR were US$ 381.15, US$ 202.37, US$ 370.56, and 9 days for each of the counterpart variables. The percentage of out-of-pocket expenses to total medical expenses was 94.24% among the HAIs inpatients, and the percentage was 96.75% among the HAIs-AMR inpatients. Conclusions: The prevalence of HAIs in the hospital was low, which might be underestimated in a resource-constrained setting. Therefore, this study can only be considered a preliminary one. Moreover, the additional direct medical economic burden was extraordinarily high among the HAIs and the HAIs-AMR inpatients, and most of the expenses were borne by themselves. A systemic solution for sustainable governance is required.

Keywords

• Healthcare-associated infections
• Antimicrobial resistance
• Direct medical economic burden
• Propensity score matching
• Hospital
• Nepal