367. Comparative Effectiveness of Strategies to Prevent Ventilator-Associated Pneumonia
Session: Poster Abstract Session: Community and Healthcare Acquired Pneumonia - Epidemiology
Friday, October 21, 2011
Room: Poster Hall B1
Background: Ventilator-associated pneumonia (VAP) is one of the most common healthcare-associated infections in the United States, affecting up to 20% of mechanically-ventilated patients in the absence of effective prevention strategies. VAP costs upward of $15,000 per case. Single prevention strategies such as the use of prevention bundles (elevation of the head of the bed, daily sedation holiday, and readiness to wean), specialized endotracheal tubes (ETT), oral care, probiotics, and oral and digestive decontamination have been evaluated in clinical trials. However, no previous work has examined the comparative effectiveness of these strategies. We used a decision and cost-effectiveness model to determine the most clinically and cost-effective prevention strategy.

Methods: All clinically-proven VAP prevention strategies were evaluated in a comparative effectiveness model using TreeAge Pro 2009. Model assumptions included average duration of mechanical ventilation of 5.9 days, no excess mortality associated with VAP, and all strategies maintained their mean efficacy when used in combination. Societal perspectives were considered, with a willingness-to-pay threshold of between $50,000-100,000. Literature estimates were used when available; otherwise, estimates were obtained using expert opinion. Costs were converted into 2011 dollars, and are reported in incremental cost-per-case-averted ratios. 

Results: 144 strategies were compared. The least expensive strategy included use of a suction ETT, probiotics, and oral decontamination. At a willingness-to-pay threshold of $50,000 -$100,000 per-case-prevented, the optimal strategy was use of a suction ETT, a VAP bundle, oral care, probiotics, and oral decontamination; all strategies using silver-coated and standard ETT were more costly and less effective. Strategies involving selective digestive decontamination were not cost-effective at a level of $100,000 per-case-prevented.

Conclusion: Many effective VAP prevention bundles exist. In our comparative effectiveness model, the optimal strategy for VAP prevention included a VAP bundle including oral care, oral decontamination, probiotics, and the use of suction ETT.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Westyn Branch-Elliman, MD, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, Sharon B. Wright, MD MPH, Silverman Health Care Quality Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA and Michael D. Howell, MD, MPH, Silverman Health Care Quality Institute, Beth Israel Deaconess Medical Center, Boston, MA

Disclosures:

W. Branch-Elliman, None

S. B. Wright, None

M. D. Howell, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.