REVIEW Costs of hospital-acquired infection and transferability of the estimates: a systematic review H. Fukuda • J. Lee • Y. Imanaka Received: 1 November 2010 / Accepted: 28 February 2011 / Published online: 22 March 2011 Ó Springer-Verlag 2011 Abstract Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a rela- tively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAI (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced. The aims of this study were to conduct a systematic review of published studies that have produced COHAI estimates from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From a total of 89 publications, only eight papers (9.0%) had a high level of transferability in which all components of costs were described, data for costs in each component were reported, and unit costs were estimated with actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We feel that, in order to ensure an appro- priate contribution to the infection control program deci- sion-making process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-making, as well as relevant journal reviewers and editors to recognize the importance of a transferability paradigm. Keywords Hospital-acquired infection Á Costs Á Transferability Á Costing method Introduction Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, as these infections occur with relatively high frequency [1] and each case may result in considerable damage [2]. There has been a recent increase in the frequency of published studies analyzing the incremental cost of HAIs at the hospital level, with many studies reporting quantified estimates. The driving force behind this recent increase in the number of cost of HAI (COHAI)-related research is the rationale that at least 20% of HAIs have been shown to be preventable [3]. In this way, COHAI research serves the following two purposes. Firstly, the quantification of COHAI can high- light the necessity of HAI control measures. As the con- tainment of rising healthcare costs is a common goal among industrialized nations, the prevention of HAIs could be expected to curtail unnecessary costs. Secondly, COHAI quantifications can contribute to elucidating the savings effect necessary in the calculation of cost-effectiveness and cost-savings of HAI control measures. The rising impor- tance of investigating the economic evaluations of HAI measures has been accelerated by the decision of Medicare H. Fukuda Institute for Health Economics and Policy, No. 11 Toyo-kaiji Bldg., 1-5-11, Nishi-Shinbashi, Minato-ku, Tokyo 105-0003, Japan e-mail: haruhisa.fukuda@ihep.jp J. Lee Á Y. Imanaka (&) Department of Healthcare Economics and Quality Management, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan e-mail: imanaka-y@umin.net Infection (2011) 39:185–199 DOI 10.1007/s15010-011-0095-7