Economic burden of ventilator-associated pneumonia based on total resource utilization

Marcos Restrepo, Antonio R Anzueto, Alejandro C. Arroliga, Bekele Afessa, Mark J. Atkinson, Ngoc J. Ho, Regina Schinner, Ronald L. Bracken, Marin H. Kollef

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Abstract

OBJECTIVES. To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals. DESIGN AND SETTING. We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%). METHODS. Case patients with microbiologically confirmed VAP (n = 30 ) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP ( n = 90 ). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups. RESULTS. Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients ( P < .001 ); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients ( P = .001 ). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151 ). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; ) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001 ). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P< .001) and respiratory therapy (P<.05). CONCLUSIONS. VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP. TRIAL REGISTRATION. NASCENT study ClinicalTrials.gov Identifier: NCT00148642.

Original languageEnglish (US)
Pages (from-to)509-515
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume31
Issue number5
DOIs
StatePublished - May 1 2010

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Ventilator-Associated Pneumonia
Economics
Hospital Costs
Costs and Cost Analysis
Diagnosis-Related Groups
Silver
Respiratory Therapy
APACHE
Intubation
Intensive Care Units
Inpatients

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

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Economic burden of ventilator-associated pneumonia based on total resource utilization. / Restrepo, Marcos; Anzueto, Antonio R; Arroliga, Alejandro C.; Afessa, Bekele; Atkinson, Mark J.; Ho, Ngoc J.; Schinner, Regina; Bracken, Ronald L.; Kollef, Marin H.

In: Infection Control and Hospital Epidemiology, Vol. 31, No. 5, 01.05.2010, p. 509-515.

Research output: Contribution to journalArticle

Restrepo, M, Anzueto, AR, Arroliga, AC, Afessa, B, Atkinson, MJ, Ho, NJ, Schinner, R, Bracken, RL & Kollef, MH 2010, 'Economic burden of ventilator-associated pneumonia based on total resource utilization', Infection Control and Hospital Epidemiology, vol. 31, no. 5, pp. 509-515. https://doi.org/10.1086/651669
Restrepo, Marcos ; Anzueto, Antonio R ; Arroliga, Alejandro C. ; Afessa, Bekele ; Atkinson, Mark J. ; Ho, Ngoc J. ; Schinner, Regina ; Bracken, Ronald L. ; Kollef, Marin H. / Economic burden of ventilator-associated pneumonia based on total resource utilization. In: Infection Control and Hospital Epidemiology. 2010 ; Vol. 31, No. 5. pp. 509-515.
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abstract = "OBJECTIVES. To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals. DESIGN AND SETTING. We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3{\%}). METHODS. Case patients with microbiologically confirmed VAP (n = 30 ) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP ( n = 90 ). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups. RESULTS. Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients ( P < .001 ); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients ( P = .001 ). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151 ). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; ) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001 ). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P< .001) and respiratory therapy (P<.05). CONCLUSIONS. VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP. TRIAL REGISTRATION. NASCENT study ClinicalTrials.gov Identifier: NCT00148642.",
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AU - Restrepo, Marcos

AU - Anzueto, Antonio R

AU - Arroliga, Alejandro C.

AU - Afessa, Bekele

AU - Atkinson, Mark J.

AU - Ho, Ngoc J.

AU - Schinner, Regina

AU - Bracken, Ronald L.

AU - Kollef, Marin H.

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N2 - OBJECTIVES. To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals. DESIGN AND SETTING. We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%). METHODS. Case patients with microbiologically confirmed VAP (n = 30 ) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP ( n = 90 ). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups. RESULTS. Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients ( P < .001 ); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients ( P = .001 ). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151 ). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; ) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001 ). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P< .001) and respiratory therapy (P<.05). CONCLUSIONS. VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP. TRIAL REGISTRATION. NASCENT study ClinicalTrials.gov Identifier: NCT00148642.

AB - OBJECTIVES. To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals. DESIGN AND SETTING. We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%). METHODS. Case patients with microbiologically confirmed VAP (n = 30 ) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP ( n = 90 ). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups. RESULTS. Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients ( P < .001 ); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients ( P = .001 ). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151 ). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; ) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001 ). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P< .001) and respiratory therapy (P<.05). CONCLUSIONS. VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP. TRIAL REGISTRATION. NASCENT study ClinicalTrials.gov Identifier: NCT00148642.

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