Infection Control & Hospital Epidemiology

Original Article

Is Continuous Subglottic Suctioning Cost-Effective for the Prevention of Ventilator-Associated Pneumonia?

Corinne Hallaisa1, Véronique Merlea1 c1, Pierre-Gildas Guitarda2, Anne Moreaua1, Valérie Josseta1, Denis Thillarda1, Suzanne Haghighata3, Benoit Vebera2 and Pierre Czernichowa1

a1 Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France

a2 Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France

a3 Pharmacy Department, Rouen University Hospital, Rouen, France

Abstract

Objective. To establish whether continuous subglottic suctioning (CSS) could be cost-effective.

Design. Cost-benefit analysis, based on a hypothetical replacement of conventional ventilation (CV) with CSS.

Setting. A surgical intensive care unit (SICU) of a tertiary care university hospital in France.

Patients. All consecutive patients receiving ventilation in the SICU in 2006.

Methods. Efficacy data for CSS were obtained from the literature and applied to the SICU of our hospital. Costs for CV and CSS were provided by the hospital pharmacy; costs for ventilator-associated pneumonia (VAP) were obtained from the literature. The cost per averted VAP episode was calculated, and a sensitivity analysis was performed on VAP incidence and on the number of tubes required for each patient.

Results. At our SICU in 2006, 416 patients received mechanical ventilation for 3,487 ventilation-days, and 32 VAP episodes were observed (7.9 episodes per 100 ventilated patients; incidence density, 9.2 episodes per 10,000 ventilation-days). Based on the hypothesis of a 29% reduction in the risk of VAP with CSS than CV, 9 VAP episodes could have been averted. The additional cost of CSS for 2006 was estimated to be €10,585.34. The cost per averted VAP episode was €1,176.15. Assuming a VAP cost of €4,387, a total of 3 averted VAP episodes would neutralize the additional cost. For a low VAP incidence of 6.6%, the cost per averted VAP would be €1,323. If each patient required 2 tubes during ventilation, the cost would be €1,383.69 per averted VAP episode.

Conclusion. Replacement of CV with CSS was cost-effective even when assuming the most pessimistic scenario of VAP incidence and costs.

(Received March 08 2010)

(Accepted August 13 2010)

Correspondence

c1 Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France (veronique.merle@chu-rouen.fr)