Grant # R01 NR010822
Title: DISTRIBUTION OF THE COSTS OF ANTIMICROBIAL RESISTANT INFECTIONS
PI: Sherry A. Glied, PhD, Professor and Chair, Department of Health Policy and Management, Mailman School of Public Health
Funder: National Institute of Nursing Research, National Institutes of Health
Dates: 9/28/07 - 5/31/12
Funding: $1,664,505

The project will develop estimates of the distribution of the extra costs associated with antimicrobial resistance and assess how policies that change incentives could spur adoption of effective interventions.

|  Project Summary  |  Research Team  |  View in CRISP Database  |
 

PROJECT SUMMARY

Interventions that could substantially reduce the burden of antimicrobial resistance exist, but the pace of adoption of these measures has been slow. One barrier to adoption is the mismatch between who pays the costs of reducing infections and resistance – predominantly health care providers -- and who gains the benefits -- the provider, payers, infected patients, as well as other current patients and future patients who could become infected. In economic terms, there are large externalities of action around the reduction of antimicrobial resistance, which reduce the financial incentives to invest in measures that reduce resistance.  The proposed research will develop estimates of the distribution of the extra costs associated with antimicrobial resistance and assess how policies that change incentives could spur adoption of effective interventions. It will supplement two existing strands of research. Economists have described the existence of externalities in theory, and have produced global level estimates of the potential size of these effects, with limited reference to specific situations or pathogens. Health services researchers have estimated the costs of resistance in the case of particular pathogens, but without reference to the allocation of these costs.  We will build on these literatures and estimate the total costs of resistance by pathogen in hospital settings.  We will compare these costs by type of pathogen and by whether the infection is community- or hospital-associated.  We will then examine two sources of mismatch between costs and benefits. First, using payment data, we will compare the allocation of costs between payers and hospitals across a range of insurers, who use different payment systems. Second, the allocation of costs between the index patient and other patients depends on how care for other patients is affected by resistant cases. We will examine the costs (and payments) for other patients exposed to a resistant case and estimate these incremental costs. Next, we will assess policy options that would change payment policies. We will use data from the CIRAR study of NICU interventions (Saiman) to assess how changes in payment policy will affect incentives to adopt a particular intervention. We will estimate how total payments for resistant and susceptible infections in the hospital would vary under alternative payment strategies and, based on this model, estimate net revenues associated with resistant or susceptible infection in each hospital. Data for these analyses will be drawn from four NYC hospital sites that are part of the same hospital system but serve very different populations with distinct payer profiles. All hospital sites have well-developed infection control database systems. We will link these infection control data to hospital cost accounting data, patient location records, and order entry data. The analyses will match patients with resistant infections (hospital- and community-acquired) to susceptible patients and to uninfected patients.

RESEARCH TEAM
Click on name to view faculty profile or send e-mail
 

Name	Role	Institution / Department
Sherry A. Glied, PhD Professor of Health Policy and Management and Department Chair	Principal Investigator	Department of Health Policy and Management, Mailman School of Public Health, Columbia University
Elaine L. Larson, RN, PhD Professor of Therapeutic and Pharmaceutical Research and Professor of Epidemiology	Co-Investigator and Nurse Epidemiologist	Columbia University School of Nursing and Department of Epidemiology, Mailman School of Public Health, Columbia University
E. Yoko Furuya, MD, MS Instructor in Clinical Medicine and Assistant Director of Hospital Epidemiology	Co-Investigator	Department of Medicine, Division of Infectious Diseases, Columbia University, and NewYork-Presbyterian Hospital, Columbia University Medical Center
Joshua Graff Zivin, PhD Assistant Professor of Health Policy and Management	Co-Investigator	Department of Health Policy and Management, Mailman School of Public Health, Columbia University
Jennifer L. Hill, PhD Assistant Professor of Public Affairs	Statistical Consultant	School of International and Public Affairs, Columbia University
Sandra R. Hyman, RN, MPA, CIC Epidemiology Research Nurse	Co-Investigator	NewYork-Presbyterian Hospital, Columbia University Medical Center
David W. Caplan, BS Director, Clinical Information Support Services	Co-Investigator	Information Services Division - Business Solutions Group, NewYork-Presbyterian Hospital, Columbia University Medical Center
Bevin Cohen, BA	Project Director	Columbia University School of Nursing

Back to Top

Supported by the
National Institute of Nursing Research/National Institutes of Health