title: Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients.
  
  
  RESULTS
  Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars 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
  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 dollars, 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.
authors.affiliation: Department of Surgery, Atrium Heerlen, The Netherlands.
authors.forename: Christianne A
authors.initials: CA
authors.lastname: van Nieuwenhoven
authors.forename: Erik
authors.initials: E
authors.lastname: Buskens
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Bergmans
authors.forename: Frank H
authors.initials: FH
authors.lastname: van Tiel
authors.forename: Graham
authors.initials: G
authors.lastname: Ramsay
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
mesh_terms: D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000379:methods; D003666:Decontamination / Q000191:economics / Q000379:methods*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D009055:Mouth / Q000382:microbiology; D011015:Pneumonia, Aspiration / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control*; D011336:Probability; D012016:Reference Values; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018709:Statistics, Nonparametric; D012122:Ventilators, Mechanical / Q000009:adverse effects / Q000382:microbiology*