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Economic Burden of Ventilator-Associated Pneumonia Based on Total Resource Utilization

Published online by Cambridge University Press:  02 January 2015

Marcos I. Restrepo*
Affiliation:
Veterans Evidence-Based Research Dissemination Implementation Center, San Antonio South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio University of Texas Health Science Center at San Antonio, San Antonio
Antonio Anzueto
Affiliation:
South Texas Veterans Health Care System, Audie L. Murphy Division, San Antonio University Hospital, San Antonio University of Texas Health Science Center at San Antonio, San Antonio
Alejandro C. Arroliga
Affiliation:
Scott & White and the Texas A&M Health Science Center College of Medicine, Temple, Texas
Bekele Afessa
Affiliation:
Mayo Clinic College of Medicine, Rochester, Minnesota, California
Mark J. Atkinson
Affiliation:
Health Services Research Center, University of California, San Diego, California
Ngoc J. Ho
Affiliation:
Department of Research and Evaluation, Kaiser Permanente, Pasadena, California
Regina Schinner
Affiliation:
FGK Clinical Research GmbH, Munich, Germany
Ronald L. Bracken
Affiliation:
C.R. Bard, Covington, Georgia
Marin H. Kollef
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
*
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Science Center at San Antonio, and Veterans Evidence-Based Research Dissemination Implementation Center at South Texas Veterans Health Care System, Audie L. Murphy Division, 7400 Merton Minter Boulevard (11C6), San Antonio, TX 78229-4404, (restrepom@uthscsa.edu)

Abstract

Objectives.

To characterize the current economic burden of ventilator-associated pneumonia (VAP) and to determine which services increase the cost of VAP in North American hospitals.

Design and Setting.

We performed a retrospective, matched cohort analysis of mechanically ventilated patients enrolled in the North American Silver-Coated Endotracheal Tube (NASCENT) study, a prospective, randomized study conducted from 2002 to 2006 in 54 medical centers, including 45 teaching institutions (83.3%).

Methods.

Case patients with microbiologically confirmed VAP (n = 30) were identified from 542 study participants with claims data and were matched by use of a primary diagnostic code, and subsequently by the Acute Physiology and Chronic Health Evaluation II score, to control patients without VAP (n = 90). Costs were estimated by applying hospital-specific cost-to-charge ratios based on all-payer inpatient costs associated with VAP diagnosis-related groups.

Results.

Median total charges per patient were $198,200 for case patients and $96,540 for matched control patients (P <.001); corresponding median hospital costs were $76,730 for case patients and $41,250 for control patients (P = .001). After adjusting for diagnosis-related group payments, median losses to hospitals were $32,140 for case patients and $19,360 for control patients (P = .151). The median duration of intubation was longer for case patients than for control patients (10.1 days vs 4.7 days; P < .001), as were the median duration of intensive care unit stay (18.5 days vs 8.0 days; P < .001) and the median duration of hospitalization (26.5 days vs 14.0 days; P < .001). Examples of services likely to be directly related to VAP and having higher median costs for case patients were hospital care (P < .05) and respiratory therapy (P < .05).

Conclusions.

VAP was associated with increased hospital costs, longer duration of hospital stay, and a higher number of hospital services being affected, which underscores the need for bundled measures to prevent VAP.

Trial Registration.

NASCENT study ClinicalTrials.gov Identifier: NCT00148642.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Levit, K, Wier, L, Stranges, E, Elixhauser, A. HCUP facts and figures: statistics on hospital-based care in the United States, 2007. Rockville, MD: Agency for Healthcare Research and Quality, 2009:190. http://www.hcup-us.ahrq.gov/reports/factsandfigures/2007/pdfs/FF_report_2007.pdf. Accessed September 24, 2009.Google Scholar
2.Cooper, LM, Linde-Zwirble, WT. Medicare intensive care unit use: analysis of incidence, cost, and payment. Crit Care Med 2004;32:22472253.CrossRefGoogle ScholarPubMed
3.Dasta, JF, McLaughlin, TP, Mody, SH, Piech, CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005;33:12661271.CrossRefGoogle ScholarPubMed
4.Hugonnet, S, Eggimann, P, Borst, F, Maricot P, Chevrolet, JC, Pittet, D. Impact of ventilator-associated pneumonia on resource utilization and patient outcome. Infect Control Hosp Epidemiol 2004;25:10901096.CrossRefGoogle ScholarPubMed
5.Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:21842193.CrossRefGoogle ScholarPubMed
6.Warren, DK, Shukla, SJ, Olsen, MA, et al.Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31:13121317.CrossRefGoogle Scholar
7.Rello, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:21152121.CrossRefGoogle Scholar
8.Boyce, JM, Potter-Bynoe, G, Dziobek, L, Solomon, SL. Nosocomial pneumonia in Medicare patients: hospital costs and reimbursement patterns under the prospective payment system. Arch Intern Med 1991;151:11091114.CrossRefGoogle ScholarPubMed
9. Federal Register Part II, Medicare Program. Proposed changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates: proposed rule, 42 CFR parts 411, 412, 413, 422, and 489 (2008).Google Scholar
10.Anderson, DJ, Kirkland, KB, Kaye, KS, et al.Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol 2007;28:767773.CrossRefGoogle ScholarPubMed
11.Kollef, MH, Afessa, B, Anzueto, A, et al.Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial. JAMA 2008;300:805813.CrossRefGoogle ScholarPubMed
12.Restrepo, MI, Anzueto, A, Arroliga, AC, et al.Economic burden of ventilator-associated pneumonia based on total resource utilization. Paper presented at: CHEST 2008: American College of Chest Physicians 74th Annual Scientific Assembly; October 25-30, 2008; Philadelphia, PA.Google Scholar
13.Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388416.CrossRefGoogle ScholarPubMed
14.Pingleton, SK, Fagon, JY, Leeper, KV Jr. Patient selection for clinical investigation of ventilator-associated pneumonia: criteria for evaluating diagnostic techniques. Chest 1992;102:S553S556.CrossRefGoogle ScholarPubMed
15. Department of Health and Human Services. Centers for Medicare and Medicaid Services (CMS): Medicare Program; proposed change in methodology for determining payment for extraordinarily high-cost cases (cost outliers) under the acute care hospital inpatient prospective payment system, 68 Federal Register 10420 (2003). 42 CFR Part 412 [CMS-1243-P] RIN 0938-AM41. http://edocket.access.gpo.gov/2003/03-5121.htm. Accessed February 22, 2010.Google Scholar
16. Centers for Medicare and Medicaid Services (CMS). Historical impact files for FY 1994 through present. http://www.cms.hhs.gov/AcuteInpatientPPS/HIF/. Accessed October 1, 2009.Google Scholar
17.Tablan, OC, Anderson, LJ, Besser, R, Bridges, C, Hajjeh, R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53:136.Google ScholarPubMed
18.Dodek, P, Keenan, S, Cook, D, et al.Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004;141:305313.CrossRefGoogle ScholarPubMed
19.Zack, JE, Garrison, T, Trovillion, E, et al.Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002;30:24072412.CrossRefGoogle ScholarPubMed
20.Babcock, HM, Zack, JE, Garrison, T, et al.An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125:22242231.CrossRefGoogle Scholar
21.Lai, KK, Baker, SP, Fontecchio, SA. Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness. Infect Control Hosp Epidemiol 2003;24:859863.CrossRefGoogle ScholarPubMed
22.Ricart, M, Lorente, C, Diaz, E, Kouef, MH, Rello, J. Nursing adherence with evidence-based guidelines for preventing ventilator-associated pneumonia. Crit Care Med 2003;31:26932696.CrossRefGoogle ScholarPubMed
23.Cook, D. Ventilator associated pneumonia: perspectives on the burden of illness. Intensive Care Med 2000;26(suppl 1):S31S37.CrossRefGoogle Scholar
24.Rello, J, Lorente, C, Bodi, M, Diaz, E, Ricart, M, Kollef, MH. Why do physicians not follow evidence-based guidelines for preventing ventilator-associated pneumonia? A survey based on the opinions of an international panel of intensivists. Chest 2002;122:656661.CrossRefGoogle Scholar
25.Craven, DE. Preventing ventilator-associated pneumonia in adults: sowing seeds of change. Chest 2006;130:251260.CrossRefGoogle Scholar
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