Ventilator-associated pneumonia: opportunity cost analysis

Background: The nosocomial pneumonia is the second most frequent infection in hospitals and most expensive one, representing an increase in patient hospitalization of 5.5 days and cost about U$5,683.00. Mecanical ventilation (MV) is responsible for most of infections in critically ill patients. In these patients with ventilator-associated pneumonia (VAP), the morbidity and mortality are significantly high, ranging from 24 to 50%, and, reaching 70% when caused by multiresistant organisms. Nowadays the modern hospital management makes the infection controllers to carefully direct their actions towards the prevention of infections based not just in the pathophysiological aspects of the disease, but also in cost analysis of the diseases. The concept of opportunity cost focus mainly in the extra length of stay of patients caused by the disease, which can be considered wasted days or opportunity treatment days (OTD), and could be used to other patients. Objective: The present study had the objective to describe the costs, the length of stay and mortality of VAP patients, as well as to perform an opportunity cost analysis. Methods: We conducted a descriptive qualitative study in VAP patients and non VAP patients exposed to MV in the Intensive Care Unit (ICU) of a private hospital from 2006 to 2008. The data was extracted from the patients records. Methods: We conducted a descriptive qualitative study in VAP patients and non VAP patients exposed to MV in the Intensive Care Unit (ICU) of a private hospital from 2006 to 2008. The data was extracted from the patients records.

Results: Eighty two patients had VAP during the study period, which represents 5.9% of patients exposed to MV. These represents a VAP rate of 10.26/1000 ventilators days. The death rate of VAP patients was 72.5% (59). The mean ICU length of stay of VAP patients was 37,73±26,72 days. Then mean ICU cost of a VAP event was R$14.423,93, representing a total of R$1.182.762,33 extra expending for the 82 patiens of the study. We had a total of 2,126 OTD attributable to VAP in the ICU. Our global ICU mean length of stay is 9.8 days, thus 216 patients could use this ICU beds during the study period. Conclusions: The 5.9% VAP rate found in our study is consistent with the literature data, ranging from 6 to 52%. Our death rate of 72.5% is considered to be high. The mean ICU length of stay of VAP patients was 3.6 timer higher that of non VAP patients, generating a mean extra 25.93 days in ICU stay. These findings corroborate the magnitude of the disease in question and the importance of implementing effective measures of prevention.