title: 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.
  
  
  METHODS
  Cost-benefit analysis, based on a hypothetical replacement of conventional ventilation (CV) with CSS.
  
  
  METHODS
  A surgical intensive care unit (SICU) of a tertiary care university hospital in France.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Replacement of CV with CSS was cost-effective even when assuming the most pessimistic scenario of VAP incidence and costs.
authors: Department of Epidemiology and Public Health, Rouen University Hospital, Rouen, France.
authors: Corinne
authors: C
authors: Hallais
authors: Véronique
authors: V
authors: Merle
authors: Pierre-Gildas
authors: PG
authors: Guitard
authors: Anne
authors: A
authors: Moreau
authors: Valérie
authors: V
authors: Josset
authors: Denis
authors: D
authors: Thillard
authors: Suzanne
authors: S
authors: Haghighat
authors: Benoit
authors: B
authors: Veber
authors: Pierre
authors: P
authors: Czernichow
mesh_terms: D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005602:France / Q000453:epidemiology; D005931:Glottis; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000191:economics*; D053717:Pneumonia, Ventilator-Associated / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D013396:Suction / Q000191:economics*