A cost-effectiveness analysis of reducing ventilator-associated pneumonia at a Danish ICU with ventilator bundle

Abstract

Background:More than 100,000 patients each year in Denmark experience nosocomial infections, erroneous medication, or pressure ulcers while hospitalized. The Danish Safer Hospital Program includes 12 bundles for improving patient safety through the introduction and maintenance of evidence-based routine treatment or standard procedures.Objective:To determine cost-effectiveness of implementing the Ventilator bundle (VB), thereby reducing ventilator-associated pneumonia (VAP), when treating a ventilated patient, compared to standard procedure.Setting and patients:A hypothetical population of intensive care patients in a Danish ICU, ventilated for >48 h.Methods:Cost-effectiveness analysis of the implementation of VB. The outcomes were prevention of VAP and prevention of death. Model inputs were evidence based from literature along with data from Kolding Hospital. A hypothetical population of intensive care patients in a Danish ICU, ventilated for >48 h was used.Results:The cost per VAP episode prevented was ∼€4451, and cost per death prevented was ∼€31,792. The incremental cost-effectiveness scatter plot showed that VB was more effective in 99.9%, and 42.6% have lower cost and better outcome for prevention of VAP. The incremental cost-effectiveness scatter plot showed that VB was more effective in 85.9%, and 31.6% have lower cost and better outcome for death prevented.Limitations:The study was a retrospective cost analysis where incidence rates were based on best evidence, even if it did not cover all elements in the VB. The perspective of this study was seen from a third-party payer, e.g., the hospital, thus societal costs and direct medical costs post-hospitalization for patients with VAP were not considered.Conclusion:We found that implementation of VB is potentially cost-effective when considering prevention of one case of VAP or death, based on a Danish ICU as a case study.