Economic Analysis of a Pediatric Ventilator-Associated Pneumonia Prevention Initiative in Nicaragua

Edward I Broughton,María Mercedes Somarriba,Sergio R López,María Nela Aguilar,Magaly Pérez,Nieves Sánchez

doi:10.1155/2012/359430

Abstract

We performed an economic analysis of an intervention to decrease ventilator-associated pneumonia (VAP) prevalence in pediatric intensive care units (PICUs) at two Nicaraguan hospitals to determine the cost of the intervention and how effective it needs to be in order to be cost-neutral. A matched cohort study determined differences in costs and outcomes among ventilated patients. VAP cases were matched by sex and age for children older than 28 days and by weight for infants under 28 days old to controls without VAP. Intervention costs were determined from accounting and PICU staff records. The intervention cost was approximately $7,000 for one year. If VAP prevalence decreased by 0.5%, hospitals would save $7,000 and the strategy would be cost-neutral. The finding that the intervention required only modest effectiveness to be cost-neutral and has potential to generate substantial cost savings argues for implementation of VAP prevention strategies in low-income countries like Nicaragua on a broader scale.

Highlights

Ventilator-associated pneumonia (VAP), defined as pneumonia occurring more than 48 h after the initiation of endotracheal intubation and mechanical ventilation, is the cause of significant morbidity and mortality in critically ill patients [1, 2]
A quality improvement (QI) intervention was implemented in two hospitals in Managua, Nicaragua, by United States Agency for International Development (USAID)’s Health Care Improvement Project (HCI) in partnership with the Ministry of Health (MINSA)
This study is an economic analysis of the QI intervention to decrease VAP prevalence in pediatric intensive care units (PICUs) in the two hospitals from the perspective of MINSA and HCI

Summary

Introduction

Ventilator-associated pneumonia (VAP), defined as pneumonia occurring more than 48 h after the initiation of endotracheal intubation and mechanical ventilation, is the cause of significant morbidity and mortality in critically ill patients [1, 2]. One study conducted in the USA reported the business case for decreasing VAP in PICU settings [6]. The incidence of VAP among pediatric patients has been reported at between 16 and 53 cases per 1,000 ventilatordays in Nicaraguan hospitals [8]. This is higher than the 10 per 1,000 ventilator days in Taiwan and the 3.7 per 1,000 ventilator days in the USA [9, 10]. This study is an economic analysis of the QI intervention to decrease VAP prevalence in PICUs in the two hospitals from the perspective of MINSA and HCI.

Methods

Results

Conclusion