Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units

Objective: Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. Design: Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. Data Source: Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were $351 per patient ($32 per patient per day). All other costs were derived from the hospital administrative database for all individual patients. Results of Base-Case Analysis: Prevention of VAP led to mean total costs of $16,119 and $18,268 for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. Results of Sensitivity Analysis: Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is < 0.923, the costs of the intervention are less than $2,500, and the prevalence of VAP without intervention is > 4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. Conclusions: This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.