Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1463 (doi:10.1542/peds.2005-1054)

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Are the Costs Attributable?

Troy E. Dominguez, MD
Joel D. Portnoy, MD
Department of Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia
University of Pennsylvania
Philadelphia, PA 19104

To the Editor.—

We read with interest the article by Elward et al1 regarding attributable costs of nosocomial bloodstream infections in patients in the PICU. The authors identified a similar increase in costs ($32219) in their patients as others have reported previously with regards to nosocomial infections and bloodstream infections ($32000 and $46000, respectively).2,3 The authors state that their study demonstrates higher attributable costs because they accounted for only direct costs in their study, and previous studies had included both direct and indirect costs. It is notable that the direct costs calculated in the Elward et al study may be inflated, because the authors did not adjust for the costs incurred before the development of a nosocomial infection in the cases. In other studies, cases have been matched with controls whose length of stay was as long as the case's before the onset of the event. In this way, after controlling/adjusting for other factors, the attributable difference in costs or other outcome can be calculated.3,4 While taking into account the cost distribution, the methodology the authors used to calculate costs does not seem to take into account this contribution to the difference in costs. Therefore, there may be bias toward overestimating direct costs. It is unclear from their Table 5 what the coefficients of the regression on costs represent [eg, proportional change in costs if ln(cost) was the dependent variable]. In addition, this is the only regression model presented in their results. Two were mentioned in their methods section and would be necessary to calculate the difference in exponential conditional means for predicted costs in the cases and controls.

REFERENCES

1. Elward AM, Hollenbeak CS, Warren DK, Fraser VJ. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics. 2005;115 :868 –872[Abstract/Free Full Text]
2. Slonim AD, Kurtines HC, Sprague BM, Singh N. The costs associated with nosocomial bloodstream infections in the pediatric intensive care unit. Pediatr Crit Care Med. 2001;2 :170 –174[CrossRef][Medline]
3. Dominguez TE, Chalom R, Costarino AT. The impact of adverse patient occurrences on hospital costs in the pediatric intensive care unit. Crit Care Med. 2001;29 :169 –174[Medline]
4. Pittet D, Tarara D, Wenzel R. Nosocomial blood stream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271 :1598 –1601[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Dominguez, T. E. Articles by Portnoy, J. D. Search for Related Content PubMed PubMed Citation Articles by Dominguez, T. E. Articles by Portnoy, J. D. Related Collections Premature & Newborn Social Bookmarking                         What's this?