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

Published online by Cambridge University Press:  02 January 2015

Corinne Hallais ,
Véronique Merle ,
Pierre-Gildas Guitard ,
Anne Moreau ,
Valérie Josset ,
Denis Thillard ,
Suzanne Haghighat ,
Benoit Veber  and
Pierre Czernichow
Corinne Hallais
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Véronique Merle*
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Pierre-Gildas Guitard
Affiliation:
Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
Anne Moreau
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Valérie Josset
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Denis Thillard
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
Suzanne Haghighat
Affiliation:
Pharmacy Department, Rouen University Hospital, Rouen, France
Benoit Veber
Affiliation:
Surgical Intensive Care Unit, Rouen University Hospital, Rouen, France
Pierre Czernichow
Affiliation:
Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France
*
Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France (veronique.merle@chu-rouen.fr)
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 131 - 135
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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