High Price Tag for Blood Infections in Pediatric Transplant, Cancer Patients

Pediatric stem cell transplant and cancer patients hospitalized with central-line associated bloodstream infections (CLABSIs) are hit with high costs, new research finds.

Published in Pediatric Blood & Cancer, the findings were part of the second phase of a collaboration among children’s hospitals to reduce CLABSIs. In the first phase, inpatient CLABSIs were reduced by 28% in less than 3 years.

This phase was conducted by members of the Children’s Hospital Association Childhood Cancer and Blood Disorders Network, and published by Pediatrics in 2014. The newest phase focused primarily on increasing knowledge and reducing CLABSIs that originate in the home between outpatient clinic visits, since a large portion of pediatric oncology and stem cell transplant patient care is performed in ambulatory settings.

“This issue has resonance beyond the pediatric stem cell transplant and oncology patient population,” said senior study author Amy Billet, MD. “At a time when many aspects of care are being shifted to the home and of heightened attention to safety and cost, this is the new frontier. What we learn about preventing outpatient bloodstream infections in these patients could have broad relevance.”

For the second phase of the study, researchers sought to determine the economic and hospitalization impact of ambulatory CLABSIs. They retrospectively analyzed data on outpatient bloodstream infections at Dana-Farber/Boston Children’s Hospital that resulted in hospitalization between January 1, 2012 and December 31, 2013.

Seventy-four bloodstream infections were analyzed in 61 patients, 69% of which were classified as CLABSIs. The patient’s central line had to be surgically removed in 43% of cases, while in 15% of cases, the child was transferred to the ICU.

There were 4 patients who died during hospitalization, and 3 of the deaths were associated with infections. Of the hospitalizations analyzed, the researchers found that most (62) were solely due to bloodstream infections, and the remainder involved at least 1 other medical issue.

When researchers calculated median charges for children treated for bloodstream infection only, they found that it cost $36,000 for a 6-day hospital stay. For those who were hospitalized for an infection along with 1 or more medical issues, the median charges were $40,000 for a 7-day hospital stay.

“Behind these metrics are real and serious risks for patients’ health,” said lead study author Chris Wong, MD, pediatric oncologist at Dana-Farber/Boston Children’s. “The bottom line is that the dollar cost and lengthy hospital stays signal complications that could become life-threatening or delay treatment of the children’s cancer. Reducing these infections is important both for cost containment and quality of care.”

Currently, at Dana-Farber/Boston Children’s outpatient clinic, researchers found that children with external lines account for one-quarter of its line days and three-quarters of its outpatient CLABSIs. In an attempt to reduce outpatient CLABSIs, the outpatient clinic added staff and developed additional resources to help expand training, and to give support for patients and others who provide in-home line care for children with external central lines.

“We’re trying to get our patients and line caregivers to be in the sweet spot,” Billett said. “They have the desire to do good line care. They have the ability — cognitive and physical – to do good line care. They have the opportunity to do good line care: they have the right supplies; they have a clean surface to work on. If we can get everyone in this sweet spot, we can reduce preventable infections and the harm they can cause.”