Is continuous subglottic suctioning cost-effective for the prevention of ventilator-associated pneumonia?

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.