PURPOSE: Ventilator-associated pneumonia (VAP) increases morbidity and mortality, resulting in increased inpatient costs. Unlike other cost estimation studies that focus on major cost determinants, such as length of stay, our approach provides a comprehensive analysis of utilization of the many different services that contribute to the total economic burden of VAP.
METHODS: To determine the economic burden of VAP to hospitals, we analyzed claims data from patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study. That prospective, randomized, multicenter, single-blind study was designed to evaluate a silver-coated endotracheal tube. Eligibility criteria for the economic analysis were informed consent, medical insurance claim form, mechanical ventilation, and no pneumonia at admission. Cases were defined as patients with microbiologically-confirmed VAP and were matched by primary or secondary diagnostic codes to controls who did not develop VAP. Mean charges were calculated for each service category and compared between cohorts. Costs were estimated by applying hospital-specific cost/charge ratios based on all-payer inpatient cost.
RESULTS: Thirty patients with VAP were matched to 222 controls. Mean total hospital charges ± standard deviation were $232,916 ± $134,908 for VAP cases and $115,022 ± $84,983 for controls (P < .0002); mean costs were $88,094 ± $53,874 and $44,003 ± $33,132 (P < .0001). Services with the highest mean charges were hospital (cases vs controls, $76,964 vs $33,991; P < .0001), pharmacy ($39,176 vs $22,284; P = .001), laboratory ($24,424 vs $17,959; P = .03), respiratory ($16,840 vs $10,421; P = .003), radiology ($5262 vs $3410; P = .002), cardiology ($5161 vs $1710; P < .001), and pulmonary ($3635 vs $1286; P = .02).
CONCLUSION: Patients with VAP had higher total hospital charges than controls due to increased utilization of services provided by the hospital, pharmacy, laboratory, and many other patient service units.
CLINICAL IMPLICATIONS: The higher-than expected total charges and diversity of resources utilized underscore the need for effective measures to prevent VAP.
DISCLOSURE: Marcos Restrepo, Consultant fee, speaker bureau, advisory committee, etc. C. R. Bard, Inc.; No Product/Research Disclosure Information