Length of stay and hospital costs associated with a pharmacodynamic-based clinical pathway for empiric antibiotic choice for ventilator-associated pneumonia.
OBJECTIVE
To determine hospital costs associated with the use of a clinical pathway implemented in our intensive care units (ICUs) to optimize antibiotic regimen selection for patients with ventilator-associated pneumonia (VAP) compared with costs in a historical control group treated according to prescriber preference.


METHODS
Retrospective cost analysis from the hospital perspective.


METHODS
Single, tertiary-care medical center.


METHODS
One hundred sixty-six adults with VAP from the medical, surgical, and neurotrauma ICUs (73 historical control patients [2004-2005] and 93 patients given an empiric antibiotic clinical pathway for VAP [2006-2007]).


RESULTS
The VAP clinical pathway consisted of an ICU-specific three-drug regimen that considered local minimum inhibitory concentration distributions and a pharmacodynamically optimized dosing strategy. Hospital cost data were collected and inflated to 2007 according to the consumer price index. The VAP-related length of treatment, hospitalization costs, and antibiotic costs were compared between groups. The median VAP length of treatment was 24 days (interquartile range [IQR] 13-35 days] and 11 days (IQR 7-17 days) for historical and clinical pathway groups, respectively (p<0.001). Daily hospital costs were similar for both cohorts over the first 7 days, after which costs declined significantly for patients treated with the clinical pathway (p<0.001). When controlling for baseline differences between groups and length of stay before development of VAP, patients treated with the clinical pathway had shorter lengths of ICU stay after VAP, shorter total hospital lengths of stay after VAP, and lower hospital costs after the treatment of VAP. Median total antibiotic costs for individual patients were similar between groups ($535 [IQR $261-998] vs $482 [IQR $222-985] clinical pathway vs control, p=0.45), and the proportion of VAP hospital resources consumed by antibiotics for both groups was low.


CONCLUSIONS
Although aggressive dosing of more costly antibiotics was empirically prescribed using the clinical pathway, patients in this group exhibited a shorter duration of treatment, reduced hospital length of stay after VAP, and lower hospital costs without any significant increase in antibiotic expenditures.
Nicasio
Anthony M
AM
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA.
Eagye
Kathryn J
KJ
Kuti
Effie L
EL
Nicolau
David P
DP
Kuti
Joseph L
JL
D000328:Adult; D000368:Aged; D000375:Aging; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D005260:Female; D017721:Hospital Costs; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010593:Pharmaceutical Services; D053717:Pneumonia, Ventilator-Associated / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000401:mortality; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012189:Retrospective Studies; D013223:Statistics as Topic; D015163:Superinfection / Q000517:prevention & control; D013997:Time Factors
D000900:Anti-Bacterial Agents