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

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.