Ventilator-associated pneumonia as a model for approaching cost-effectiveness and infection prevention in the ICU

Abstract

Nosocomial infection is a major cause of morbidity and mortality. In the ICU, ventilator-associated pneumonia (VAP) represents the most prevalent and visible hospital-acquired infection (HAI). Although some evidence-based strategies reduce the incidence of VAP, despite a recent policy drive toward zero VAP rates, no evidence supports feasibility of VAP eradication. Furthermore, in the era of resource constraints, cost-effectiveness of various strategies is critical to consider. Recent approaches to VAP prevention conglomerate single maneuvers into bundles. Although the cost-effectiveness of some VAP-preventive interventions, such as continuous subglottic suctioning and silver-coated endotracheal tube, has been evaluated singly, less is known about the investments needed to implement the recommended bundled approaches in the context of their ability to prevent VAP and such important downstream implications as the use of antibiotics and other hospital resources. A well designed model from Australia examining the cost-effectiveness of a catheter-related blood stream infection bundle can serve as robust scaffolding for building a credible value proposition for the VAP bundles. Cost-effectiveness of VAP prevention bundles is not known. This is a critical piece of information, particularly as it relates to such important downstream outcomes of VAP prevention as the use of antibiotics and hospital length of stay. Understanding the incremental cost-effectiveness of VAP bundles can help prioritize efforts to minimize the associated morbidity.