PURPOSE: HAP is a common infection both in and out of the ICU. Ventilator-associated pneumonia (VAP) represents 1/4 of all ICU-acquired infections. Estimates of HAP/VAP-attributable resource utilization and costs have been variable. We examined the literature and performed a meta-analysis of the economic impact of HAP/VAP.
METHODS: A thorough search of electronic databases MEDLINE and EMBASE was conducted. The search was limited to articles in English language published after 1990. Meta-analysis was conducted to provide summary estimates for excess ICU LOS, hospital LOS and costs related to HAP/VAP. The summary effect size was computed using a random effects model. Heterogeneity and publication bias were assessed using the Cochran Q-test and the Begg and Mazumdar rank correlation test, respectively.
RESULTS: Thirteen studies met pre-specified inclusion criteria. HAP/VAP added 8.37 days (95% CI: 6.34 - 10.40) to the ICU LOS (N=11). Limiting this analysis to the US (N=7) resulted in a similar point estimate (8.7 days; 95% CI: 6.17 - 11.23). The attributable hospital LOS was 11.02 days (95% CI: 9.79 - 12.26) (N=4). The pooled hospital costs attributable to HAP were $28,008 (95%CI: $89 - $55,928) (N=7) with no evidence of publication bias (Kendall's tau = 0.3926; p = 0.1735). In the 2 US/Canadian studies, the excess costs were higher ($65,589; 95% CI: $55,714 - $75,463) than in those conducted outside the US/Canada ($15,085; 95% CI: $4,190 - $25,981). Studies restricted to VAP patients (N=5) had a higher estimate of hospital costs than the overall HAP estimate ($37,442; 95% CI: 10,422 - 64,463).
CONCLUSION: HAP/VAP is associated with a considerable attributable cost, ICU and hospital LOS. These estimates remained consistent across several sensitivity analyses.
CLINICAL IMPLICATIONS: Given increased scrutiny of complication rates and the continued consideration for VAP as a non-reimbursable event, systems need to be developed and implemented to increase the use of evidence-based prevention measures. New HAP/VAP therapies should be examined for their impact on this economic burden.
DISCLOSURE: Jarrett Amsden, Employee Study and publication supported by Astellas Pharma US, Inc., Deerfield, IL. SK is an employee of Astellas.; No Product/Research Disclosure Information