Research reveals costs of blood exposures
Data diverse and limited, but 'realistic'
Information on the direct costs of postexposure follow-up for occupational blood exposures has been limited, but a recent report based on data from the Exposure Prevention Information Network (EPINet) provides a realistic glimpse of the costs associated with percutaneous and mucocutaneous exposures.1
To obtain the information, researchers from the International Health Care Worker Safety Center of the University of Virginia in Charlottesville chose two of the 70 hospitals participating in the center's EPINet data-sharing network. Through computerized data collection and analysis, EPINet provides specific identification of injury-causing needle and sharps devices. Participating hospitals do not routinely submit cost information, so the data are limited; however, safety center Director Janine Jagger, MPH, PhD, points out that the need for realistic cost information prompted her and the other researchers to publish the figures gleaned from their database.
'Unbelievable' variation between institutions"People keep asking for data on costs, so the fact that the data is [limited] is an issue in itself. These data reflect the reason we can't get good information, because what the hospitals call costs is totally different," Jagger explains. "In addition, the costs of [postexposure] tests in the two hospitals are completely different. The variation between the two institutions is absolutely unbelievable."
Nevertheless, Jagger says the information is a useful contrast to the "overblown" estimates put out by some manufacturers that market safer needle devices. It also has instructive value.
"People can see what real-world data looks like on this topic, and they can start to scrutinize it and understand what at least some of the issues are in trying to document costs. Hospitals already know there's a cost to following up needlesticks, but this would be helpful information for people who are trying to come up with a national figure for exposure costs. With all of its flaws, it's very realistic," she says.
EPINet report forms include four cost-related categories: blood test lab charges; charges for treatments such as hepatitis B vaccine, hepatitis B immune globulin, tetanus vaccine, and HIV chemoprophylactic drugs; service charges for employee health or emergency department visits, or other services; and other costs, such as surgery.
Both hospitals selected for the cost information report had more than 450 occupied beds. Hospital A was a community facility in a high-HIV-prevalence area, while hospital B was a teaching institution in a low-HIV-prevalence area. Cost data presented were from June 1, 1995, through May 31, 1997, capturing treatment cost differences possibly attributable to the U.S. Centers for Disease Control and Prevention's 1996 chemoprophylaxis guidelines for HIV-exposed health care workers.2
The report notes several data limitations: the lack of standardized definitions for what constitutes a charge or cost; no breakdown of specific tests performed or treatments provided; no indirect costs or costs of occupational infections; and the possibility that "the hospitals included in this report may not be representative of other hospitals."
Data revealed in the report include:
· The average direct cost was $672 (range = $340-$1,025) for a percutaneous injury at hospital A, where 345 cases were followed up during the study period, compared with $539 (range = $197-$1,094) at hospital B, where 594 cases were followed up.
· The average direct cost was $660 (range = $265-$975) for a mucocutaneous exposure at hospital A, with 114 cases, compared with $546 (range = $0-$1,232) at hospital B, with 334 cases.
· The average direct cost of percutaneous injuries at both hospitals before and after implementation of the CDC's 1996 chemoprophylaxis guidelines differed little. The only circumstance resulting in higher cost post-implementation was at hospital B if an exposure involved an unknown source patient.
· The average direct cost of a percutaneous injury at hospital A when the source patient was known was $673 (329 cases) and $667 when the source was unknown (16 cases). At hospital B, the average direct cost was $527 when the source patient was known (501 cases) and $605 when the source was unknown (93 cases).
· The average direct cost of percutaneous injuries for high-risk injuries (defined as injuries caused by needles that had been used to draw blood or establish intravenous access) vs. low-risk injuries at hospital A was $691 for a high-risk injury (157 cases) and $657 for a low-risk injury (188 cases). At hospital B, the cost was $532 for a high-risk injury (81 cases) and $540 for a low-risk injury (513 cases).
· The average direct cost of a mucocutaneous exposure at hospital A from June 1, 1995-May 31, 1996 was $672 (63 cases). The cost was $649 (51 cases) between June 1, 1996 and May 31, 1997. At hospital B, the cost was $541 (173 cases) during the first time period and $552 (161 cases) during the second.
· Some of the charges for specific items in follow-up protocols were as follows:
- Hospital A: Employee HBsAb, $15; employee HIV antibody panel (ELISA), $25; HBIG, $100; HBV vaccine (three doses and blood tests), $150; AZT and 3TC plus or minus IDV (four-week supply), $650; emergency department visit, $85; employee health department visit (simple), $50.
- Hospital B: Employee hepatitis profile (HBsAg, anti-HBs, anti-HBc), $141; employee HIV antibody panel (ELISA), $56; HBV vaccine (three doses), $127; HBIG (five doses), $465; AZT and 3TC plus or minus IDV (four-week supply), $598; emergency department visit, $40; employee health department visit, $60.
The researchers also examined whether injuries to employees in different job classifications or injuries involving different types of devices affected follow-up costs, but no significant cost differences were seen.
Jagger is planning a project to standardize cost definitions among hospitals, which will facilitate further study of the financial impact of occupational exposures to bloodborne pathogens.
References1. Jagger J, Bentley M, Juillet E. Direct cost of followup for percutaneous and mucocutaneous exposures to at-risk body fluids: Data from two hospitals. Advances in Exposure Prevention 1998; 3:25, 34-35.
2. Centers for Disease Control and Prevention. Update: Provisional Public Health Service recommendations for chemoprophylaxis after occupational exposure to HIV. MMWR 1996; 45:468-472.
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