An Economic Analysis of Psychotherapy for Borderline Personality Disorder Patients

BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.     

Inpatient cancer treatment: an analysis of financial and nonfinancial performance measures by hospital-ownership type

This study uses longitudinal data of inpatient treatment from the Agency for Healthcare Research and Quality's (AHRQ's) Healthcare Cost and Utilization Project (HCUP) to examine the differences in historical trends and build future projections of charges, costs, and lengths of stay (LOS) for inpatient treatment of four of the most prevalent cancer types: breast, colon, lung, and prostate. We stratify our data by hospital ownership type and for the aforementioned four major cancer types. We use the Kruskal Wallis (nonparametric ANOVA) Test and time series models to analyze variance and build projections, respectively, for mean charges per discharge, mean costs per discharge, mean LOS per discharge, mean charges per day, and mean costs per day. We find that significant differences exist in both the mean charges per discharge and mean charges per day for breast, colon, lung, and prostate cancers and in the mean LOS per discharge for breast cancer. Additionally, we find that both mean charges and mean costs are forecast to continue increasing while mean LOS are forecast to continue decreasing over the forecast period 2008 to 2012. The methodologies we employ may be used by individual hospital systems, and by health care policy-makers, for various financial planning purposes. Future studies could examine additional financial and nonfinancial variables for these and other cancer types, test for geographic disparities, or focus on procedural-level hospital measures.     

Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures]

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Skin cancer has a large impact on our public hospitals but prevention programs continue to demonstrate strong economic credentials

Objectives: While skin cancer is still the most common cancer in Australia, important information gaps remain. This paper addresses two gaps: i) the cost impact on public hospitals; and ii) an up‐to‐date assessment of economic credentials for prevention. Methods: A prevalence‐based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using State service statistics, and outpatient services based on attendance at three hospitals in 2012–13. Cost‐effectiveness for prevention was estimated from ‘observed vs expected’ analysis, together with program expenditure data. Results: Combining inpatient and outpatient costs, total annual costs for Victoria were $48 million to $56 million. The SunSmart program is estimated to have prevented more than 43,000 skin cancers between 1988 and 2010, a net cost saving of $92 million. Skin cancer treatment in public hospitals ($9.20～$10.39 per head/year) was 30‐times current public funding in skin cancer prevention ($0.37 per head/year). Conclusions: At about $50 million per year for hospitals in Victoria alone, the cost burden of a largely preventable disease is substantial. Skin cancer prevention remains highly cost‐effective, yet underfunded. Implications for public health: Increased funding for skin cancer prevention must be kept high on the public health agenda. Hospitals would also benefit from being able to redirect resources to non‐preventable conditions.     

Private choices,public costs: Evaluating cost-shifting between private and public health sectors in New Zealand

New Zealand’s dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care within the public health system, in effect shifting costs to the public sector. This study evaluates this phenomenon, examining whether cost-shifting between the private and public hospital systems is a significant issue in New Zealand.We used inpatient discharge data from 2013/14 to identify private events with a subsequent admission to a public hospital within seven days of discharge. We examined the frequency of subsequent public admissions, the demographic and clinical characteristics of the patients and estimated the direct costs of inpatient care incurred by the public health system.Approximately 2% of private inpatient events had a subsequent admission to a public hospital. Overall, the costs to the public system amounted to NZ$11.5 million, with a median cost of NZ$2800. At least a third of subsequent admissions were related to complications of a medical procedure.Although only a small proportion of private events had a subsequent public admission, the public health system incurred significant costs, highlighting the need for greater understanding and discussion around the interface between the public and private health systems.     

The Criminalization of Persons with Serious Mental Illness Living in Rural Areas

Abstract: In the context of restrictive admissions policies at public inpatient facilities, rates of arrest and incarceration of persons with serious mental illness (SMI) have been increasing, leading to the perception that SMI persons are being unduly "criminalized." This paper describes the characteristics of persons with SMI (N=177) in Mississippi who have been (1) jailed without charges while awaiting a hospital bed and (2) jailed for a criminal offense. Seventy-five percent (N=132) of the 177 subjects had been held in local jails awaiting state hospital admission at least once in their lives, most for more than five days. Fifteen percent (N=26) had contact with the police for a criminal offense in the past year. Rural residence markedly increased the risk for waiting in jail (OR=4.24) but was not related to committing a criminal offense. Protective factors for any type of criminal justice contact were female gender, caucasian ethnicity, better compliance with medication regimes, and nonrural residence. The phenomenon of rural criminalization, i.e., waiting in jail without criminal charges, differs qualitatively from the criminalization that occurs in urban areas and may require a different solution. To avoid criminalization of SMI persons in rural areas, public mental health systems must develop effective crisis interventions in the community or work with local law enforcement officials and medical and mental health facilities to create more immediate access to acute inpatient care.     

Public hospital admissions for treating complications of clinical care: incidence,costs and funding strategy

Objective: To quantify the frequency of, and the costs and payments associated with, admissions for treatment of injuries and illnesses that are consequences of care. Data sources: Routinely‐coded 2005/06 public hospital inpatient data from Victoria, Australia (1.25 million admissions) and corresponding patient‐level cost data (1.04 million admissions). Payments reflected DRG‐based prospective rates. Study design: Retrospective analysis of admissions with principal diagnoses that specify adverse events arising as a direct consequence of healthcare. Results: 1.5% (15,336) of the costed admissions specifically treat an injury or illness arising from medical or surgical care, consuming 2.74% of hospital prospective payments and representing $89.3 m (2.84%) of total reported costs. 1.4% (17,429) of all public hospital admissions and 2.82% of hospital prospective payments (estimated cost‐$101.5 m per year) are committed to treating complications of care. Private residences or aged care facilities are the source of 84.9% (14,804) of these admissions. Inpatient death was the outcome in 0.7% (118) of these admissions. Implications: Admissions for treating complications of care represent a small, relatively expensive, proportion of hospital admissions, which account for disproportionate levels of hospital costs and funding. A policy option providing incentives to reduce the incidence and costs of complications arising from care includes allocating all costs arising from transferred (re)admissions back to the original episode of care and developing a suite of specific DRGs to fund admissions for treatment of complications.     

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced.Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients.MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment).ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway.ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services.Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.     

Trends in colorectal cancer care in southern England, 1989-1993: using HES data to inform cancer services reviews

BACKGROUND: This paper describes trends in hospital activity, hospital admissions, and treatments for colorectal cancer on residents of the South Thames regions (population 8 million) between 1989-1993 against the background of the Calman Report on the future of cancer services in England and Wales. METHODS: The analyses are derived from UK hospital data, which are collected as finished consultant episodes (FCEs). These are defined as episodes "where a patient has completed a period of care under a consultant and is either transferred to another consultant or is discharged." Probability matching was used to derive patient-based records, matching FCEs to admissions. A total of 18,542 South Thames residents aged 40-99 were admitted for colorectal cancer between 1 January 1989 and 31 December 1993. Time trends were analysed for procedures, FCEs, admissions, and patient numbers by admission type (ordinary admissions and day case admissions). RESULTS: Between 1989 and 1993 inclusive colorectal cancer admissions doubled (98% increase p (trend) < 0.0001). These admissions were a result of a 6.4-fold increase in day case admissions and a 41% increase in ordinary admissions. The proportion of patients having a day case admission rose from 9% in 1989 to 18% in 1993 (p < 0.0001). Overall, 2894 (16%) patients had a day case admission; 1894 of these (65%) were also admitted as ordinary admissions. The number of FCEs and admissions per patient rose from 1.37 and 1.28 respectively in 1989 to 2.09 and 1.99 respectively in 1993. FCEs were between 5% and 8% higher than admissions over the five years. The number of ordinary (that is, overnight) inpatient admissions per patient rose from 1.23 to 1.41 over the five year period and day case inpatient admissions from 1.25 to 3.45. Chemotherapy accounted for 50% of the rise in day case admissions; colonoscopy and sigmoidoscopy were associated with a further 18%. Fourteen per cent of the increase in ordinary admissions was also because of chemotherapy. CONCLUSION: The monitoring of site specific trends in admission, treatments, and procedures on a population basis should be a core requirement of health authorities to inform needs assessment, resource allocation, and service planning. The rise in admissions and chemotherapy treatments have implications for drug costs, laboratory and inpatient services, monitoring, and clinical audit.

 

     

A test of mental health parity: Comparisons of outcomes of hospital concurrent utilization review

The Mental Health Parity Act of 1996 had as its goal the equity of coverage of mental health care and physical health care. The purpose of this study was to examine the outcomes of hospital concurrent utilization review as a measure of the progress toward the equity goal. The study examined 4 years of denials of certification for reimbursement by payers of inpatient care (1998–2001). Psychiatry was first compared to clinical services with a like number of annual admissions and then compared to clinical services with a like number of concurrent reviews. For each year, psychiatry had the highest numbers of cases denied and patient days denied. The most frequent reason for a psychiatric denial was that the inpatient benefit level had been exceeded. There was only one instance, in 4 years, when this reason (benefit limit exceeded) was given for a patient with a physical illness. This study provides evidence of the current inequity of reimbursement for treatment of mental illness.     

Managed behavioral health care: a Medicaid carve-out for youth.

This DataWatch assesses the impact of a public sector-managed Medicaid mental health carve-out pilot for North Carolina youth. Access to, volume of, and costs of mental health/substance abuse services are reported. We compared a pilot managed care program, with an incentive to shift hospital use and costs to community-based services, with usual fee-for-service Medicaid. Aggregate data from Medicaid claims for youth (from birth to age seventeen) statewide are reported for five years. We found dramatic reductions in use of inpatient care, with a shift to intensive outpatient services, and less growth in mental health costs. These findings demonstrate that public sector-managed care can be viable and more efficient than a fee-for-service model.     

PMH2 Assessment of Health-Related Quality of Life During Treatment of Opiate Dependence using the Short Form-36

In the U.S., acute general hospitals increasingly provide treatment for patients with schizophrenia.
OBJECTIVE: To estimate the average annual cost of inpatient schizophrenia care per patient in an acute general hospital setting.
METHODS: Using ICD9 codes to identify disease and procedure-level data in five state (CA, FL, MA, MD, NC) acute care, all payer, discharge databases, an average cost per admission was estimated and combined with the frequency of admission calculated from the MA database to derive a mean annual acute care inpatient cost. Physician costs were calculated by applying 1997 Medicare fees to a resource use profile derived from the databases and published treatment recommendations. All costs are reported in 1997 US$, appropriately adjusted for medical inflation and cost-to-charge ratios.
RESULTS: Of 7.5 millions discharges, 73,000 were identified as having been admitted primarily due to schizophrenia. The average length of stay was 13.5 days, with 90% of time spent in a designated psychiatric bed. Over 90% were discharged within one month, most (∼80%) to home without documentation of further services. The mean cost per stay (including physician fees) was $8,963. Most (68%) patients had only one admission, and 96% had less than five in one year, leading to annual hospitalization cost per schizophrenic patient of $13,854.
CONCLUSIONS: Of schizophrenic patients admitted to an acute general hospital, the majority are admitted only once per year, spend their stay in a designated psychiatric unit bed, and are discharged within two weeks. Although these patients may have subsequent admissions to another type of inpatient facility, the majority are not transferred to such a facility at the time of discharge.     

2011年～2017年四川省公立医院次均医疗费用影响因素研究

目的分析2011年~2017年四川省公立医院次均医疗费用的影响因素,为控制全省医疗费用的过快增长提供参考.方法通过年增长率、增长速度等指标对2011年~2017年四川省公立医院人均费用变化情况进行描述性分析,然后使用连环替代法分析各指标变动对次均费用的影响情况.结果全省人均门诊费用和人均住院费用逐年增长,其增长率均高于全国水平,但增速不断放缓.年门诊总诊疗人次和年出院人数对次均医疗费用的影响最明显,影响最小的是人口因素.结论继续强化医疗费用控制意识,不断提升卫生服务供给水平,多指标协调共同促进次均医疗费用控制.     

The association between smoking during pregnancy and hospital inpatient costs in childhood

Although the health sequelae of smoking during pregnancy are well documented, relatively little is known about its long-term economic implications. The objective of this study was to analyse individual-level data on maternal smoking behaviour and sociodemographic, perinatal and resource utilisation variables in order to estimate the association between smoking during pregnancy and hospital inpatient service utilisation and costs through the first 5 years of the infant's life. Data from the Oxford Record Linkage Study, a collection of birth registrations, death certificates and statistical abstracts of hospital inpatient and day case admissions formed the basis of the investigation. The study population comprised all infants born to women who both lived and delivered in Oxfordshire or West Berkshire during the period 1 January 1980-31 December 1989 (n = 119,028). The cost of each hospital admission, including the initial birth admission, was estimated by multiplying the length of stay by the per diem cost of the respective specialty (pound 1998-1999 sterling). The effect of maternal smoking behaviour on cumulative 5-year hospital inpatient service utilisation and costs was analysed in a series of multivariate analyses, taking account of confounding clinical and sociodemographic factors. Infants born to women who reported smoking during pregnancy were hospitalised for a significantly greater number of days than infants born to women who had either never smoked or had smoked in the past (P < 0.0001). Over the first 5 years of life, the adjusted mean cost difference was estimated at pound sterling 462 (95%CI: pound sterling 353-pound sterling 571) when infants born to women who smoked at least 20 cigarettes per day were compared to infants of non-smoking mothers, and pound sterling 307 (95%CI: pound sterling 221-pound sterling 394) when infants born to women who smoked 10-19 cigarettes per day were compared to infants of non-smoking mothers (P < 0.0001). The results of this study should add an economic dimension to the importance of providing smoking cessation services for pregnant women.     

Does hospital competition improve efficiency? The effect of the patient choice reform in England

We use the 2006 relaxation of constraints on patient choice of hospital in the English NHS to investigate the effect of hospital competition on dimensions of efficiency including indicators of resource management (admissions per bed, bed occupancy rate, proportion of day cases, and cancelled elective operations) and costs (reference cost index for overall and elective activity, cleaning services costs, laundry and linen costs). We employ a quasi differences‐in‐differences approach and estimate seemingly unrelated regressions and unconditional quantile regressions with data on hospital trusts from 2002/2003 to 2010/2011. Our findings suggest that increased competition had mixed effects on efficiency. An additional equivalent rival increased admissions per bed by 1.1%, admissions per doctor by 0.9% and the proportion of day cases by 0.38 percentage points, but it also increased the number of cancelled elective operations by 2.5%.     

Benefits and costs of a free community-based primary care clinic

This study estimates the benefits and costs of a free clinic providing primary care services. Using matched data from a free clinic and its corresponding regional hospital on a sample of newly enrolled clinic patients, patients' non-urgent emergency department (ED) and inpatient hospital costs in the year prior to clinic enrollment were compared to those in the year following enrollment to obtain financial benefits. We compare these to annual estimates of the costs associated with the delivery of primary care to these patients. For our sample (n = 207), the annual non-urgent ED and inpatient costs at the hospital fell by $170 per patient after clinic enrollment. However, the cost associated with delivering primary care in the first year after clinic enrollment cost $505 per patient. The presence of a free primary care clinic reduces hospital costs associated with non-urgent ED use and inpatient care. These reductions in costs need to be sustained for at least 3 years to offset the costs associated with the initially high diagnostic and treatment costs involved in the delivery of primary care to an uninsured population.     

Predicting Treatment Cost for Bacterial Diarrhoeaat a Regional Hospital in Thailand

The aim of this study was to estimate the treatment cost and formulate a cost-function for bacterial diarrhoea among patients in a Thai regional hospital. This study was an incidence-based cost-of-illness analysis from a hospital perspective, employing a micro-costing approach. It covered new episodes of both outpatients and inpatients who were diagnosed to have bacterial diarrhoea (ICD-10 code A00-A05) and who received treatment during 1 October 2000–31 July 2003. Retrospective data were collected from medical records of the hospital. The study covered 384 episodes, and the mean age of patients was 24 years. The average treatment costs (at 2002 prices; US$ 1=approximately 40 Thai baht) were US$ 11.29, 76.78, and 44.72 per outpatient episode, inpatient episode, and outpatient/inpatient combined episode respectively. Furthermore, the positive significant predictor variables were: inpatient care, other Salmonella-associated infections, shigellosis, other bacterial intestinal infections, and the health insurance scheme. The fitted model was able to predict greater than 80% of the treatment cost. The estimation of simulated patients demonstrated a wide range of costs, from US$ 10 per episode to US$ 163 per episode. Overall, hospital administrators can apply these results in cost-containment interventions.Key words: Bacteria, Cost-function analysis, Cost and cost analysis, Diarrhoea, Health expenditure, Healthcare cost, Retrospective studies, Thailand     

Costs and concentration of cancer care: evidence for pancreatic,oesophageal and gastric cancers in National Health Service hospitals

OBJECTIVES: To examine relationships between the cost of hospital cancer care and the degree of specialisation of patients' doctors and hospitals as indicated by their annual case-loads. METHODS: Three cohorts comprising 2294 patients with cancers of the pancreas, oesophagus and stomach in 29 acute National Health Service (NHS) hospitals in south-west England and South Wales were followed prospectively for a year. For each patient, prognostic variables, service activity and survival data were recorded, and the hospital cost of cancer care and cost per year survived were estimated. Costs were estimated from quantities of resource units provided and a single set of unit costs. Costs per day survived after presentation to hospital were calculated as estimates of cost-effectiveness. Linear regression analyses examined the effects on total costs, and on costs per day survived of doctors' and hospitals' annual patient volumes, adjusting for prognostic variables and treatments. RESULTS: General ward care rather than specific treatments and investigations accounted for most of total costs. Costs per patient increased significantly with increasing doctor volumes. After adjustment for prognosis and treatments, however, cost-volume relationships were U-shaped, reflecting more active intervention by higher volume doctors, along with little activity and long stays among patients of lower volume doctors. Cost per day survived also had U-shaped relationships with doctor volumes. Regression models using continuous rather than categorical volume terms fitted the data best. CONCLUSIONS: Doctors' specialisation is at least as important for efficiency and effectiveness as hospitals' specialisation. Cost and cost per day survived increased and then decreased with increasing doctor volumes, highlighting the need for critical attention to costs as services become highly specialised. Specialisation occurs along a continuum, with no clear volume threshold effects on survival or costs.     

Socioeconomic differences in childhood hospital inpatient service utilisation and costs: prospective cohort study

STUDY OBJECTIVE: To examine the association between socioeconomic position at the time of birth and the use and cost of hospital inpatient services during the first 10 years of life. DESIGN: Analysis of a database of linked birth registrations, hospital records, and death certificates. Associations between the social class of the head of household and hospital inpatient service utilisation and costs during the first 10 years of life were analysed using multilevel multiple regression modelling. PARTICIPANTS AND SETTING: All 117 212 children born to women who both lived and delivered in hospital in Oxfordshire or West Berkshire, southern England, during the period 1 January 1979 to 31 December 1988. MAIN RESULTS: The study showed that children born into social classes II, III-NM, III-M, IV, and V were more likely to be admitted to hospital, spend longer in hospital overall, and generate greater hospital costs than children born into social class I. The adjusted effect regarding hospital inpatient admissions, days, and costs was 1.27 (95% CI: 1.26, 1.27), 1.20 (1.19, 1.21), and 1.50 (1.49, 1.53), respectively, for children born into social class V when compared with children born into social class I. The impact of social class on hospital inpatient admissions, days, and costs was most acutely felt during years 3-10 of life as compared with the first two years of life. CONCLUSIONS: Health service decision makers need to be alert to the adverse sequelae that might result from socioeconomic disadvantage when planning health services for children. Particular attention should be paid to targeting deprived populations with prevention interventions that are known to be effective.     

The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals.

OBJECTIVES: To determine the costs associated with the management of hospitalized patients with methicillin-resistant Staphylococcus aureus (MRSA), and to estimate the economic burden associated with MRSA in Canadian hospitals. DESIGN: Patient-specific costs were used to determine the attributable cost of MRSA associated with excess hospitalization and concurrent treatment. Excess hospitalization for infected patients was identified using the Appropriateness Evaluation Protocol, a criterion-based chart review process to determine the need for each day of hospitalization. Concurrent treatment costs were identified through chart review for days in isolation, antimicrobial therapy, and MRSA screening tests. The economic burden to Canadian hospitals was estimated based on 3,167,521 hospital discharges for 1996 and 1997 and an incidence of 4.12 MRSA cases per 1,000 admissions. SETtING: A tertiary-care, university-affiliated teaching hospital in Toronto, Ontario, Canada. PATIENTS: Inpatients with at least one culture yielding MRSA between April 1996 and March 1998. RESULTS: A total of 20 patients with MRSA infections and 79 colonized patients (with 94 admissions) were identified. This represented a rate of 2.9 MRSA cases per 1,000 admissions. The mean number of additional hospital days attributable to MRSA infection was 14, with 11 admissions having at least 1 attributable day. The total attributable cost to treat MRSA infections was $287,200, or $14,360 per patient The cost for isolation and management of colonized patients was $128,095, or $1,363 per admission. Costs for MRSA screening in the hospital were $109,813. Assuming an infection rate of 10% to 20%, we determined the costs associated with MRSA in Canadian hospitals to be $42 million to $59 million annually. CONCLUSIONS: These results indicate that there is a substantial economic burden associated with MRSA in Canadian hospitals. These costs will continue to rise if the incidence of MRSA increases further.