The economic burden of patient safety targets in acute care: a systematic review

Nicole Mittmann,¹ Marika Koo,¹ Nick Daneman,² Andrew McDonald,³ Michael Baker,⁴ Anne Matlow,⁵ Murray Krahn,⁶ Kaveh Shojania,⁷ Edward Etchells<sup>7

1</sup>Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, ²Division of Infectious Diseases, ³Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ⁴Patient Safety in Ontario, University Health Network, Toronto, ON, Canada; ⁵Infection Prevention and Control and Patient Safety, Hospital for Sick Children, Toronto, ON, Canada; ⁶Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada; ⁷University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

Background: Our objective was to determine the quality of literature in costing of the economic burden of patient safety.
Methods: We selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: “costs and cost analysis,” “cost-effectiveness,” “cost,” and “financial management, hospital.” We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated.
Results: We screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414.
Conclusion: There are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed.

Keywords: patient safety, burden of illness, review, quality