Dataset Information

Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam.

ABSTRACT:

Introduction

Ventilator associated respiratory infections (VARIs) are the most common hospital acquired infections in critical care worldwide. This work aims to estimate the total annual direct hospital cost of treating VARI throughout Vietnam.

Methods

A costing model was constructed to evaluate the excess cost of diagnostics and treatment of VARI in Vietnam. Model inputs included costs for extra lengths of stay, diagnostics, VARI incidence, utilisation of ventilators and antibiotic therapy.

Results

With the current VARI incidence rate of 21.7 episodes per 1000 ventilation-days, we estimated 34,428 VARI episodes in the 577 critical care units in Vietnam per year. The extra cost per VARI episode was $1,174.90 and the total annual excess cost was US$40.4 million. A 1% absolute reduction in VARI incidence density would save US$1.86 million annually. For each episode of VARI, the share of excess cost components was 45.1% for critical care unit stay and ventilation, 3.7% for diagnostics and 51.1% for extra antimicrobial treatment.

Conclusions

At the current annual government health expenditure of US$117 per capita, VARI represents a substantial cost to the health service in Vietnam. Enhanced infection prevention and control and antimicrobial stewardship programmes should be implemented to reduce this.

SUBMITTER: Dat VQ

PROVIDER: S-EPMC6209379 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam.

Dat Vu Quoc VQ Huong Vu Thi Lan VTL Turner Hugo C HC Thwaites Louise L van Doorn H Rogier HR Nadjm Behzad B

PloS one 20181031 10

<h4>Introduction</h4>Ventilator associated respiratory infections (VARIs) are the most common hospital acquired infections in critical care worldwide. This work aims to estimate the total annual direct hospital cost of treating VARI throughout Vietnam.<h4>Methods</h4>A costing model was constructed to evaluate the excess cost of diagnostics and treatment of VARI in Vietnam. Model inputs included costs for extra lengths of stay, diagnostics, VARI incidence, utilisation of ventilators and antibiot ...[more]

PMID: 30379956

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Project description:Background:Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. Methods:We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ??16 years old and expected to be mechanically ventilated >?48 h were enrolled in the study and followed daily for 28 days following ICU admission. Results:Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients' data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p?<?0.01 for all). This was also true for all VARI (p?<?0.01 for all) with/without tetanus. There was no increased risk of in-hospital death in patients with VARI compared to those without (VAP HR 1.58, 95% CI 0.75-3.33, p?=?0.23; VARI without VAP HR 0.40, 95% CI 0.14-1.17, p?=?0.09). In patients with positive endotracheal aspirate cultures, most VARI was caused by Gram-negative organisms; the most frequent were Acinetobacter baumannii (32/73, 43.8%) Klebsiella pneumoniae (26/73, 35.6%), and Pseudomonas aeruginosa (24/73, 32.9%). 40/68 (58.8%) patients with positive cultures for these had carbapenem-resistant isolates. Patients with carbapenem-resistant VARI had significantly greater ICU costs than patients with carbapenem-susceptible isolates (6053 USD (IQR 3806-7824) vs 3131 USD (IQR 2108-7551), p?=?0.04) and after correction for adequacy of initial antibiotics and APACHE II score, showed a trend towards increased risk of in-hospital death (HR 2.82, 95% CI 0.75-6.75, p?=?0.15). Conclusions:VARI in a resource-restricted setting has limited impact on mortality, but shows significant association with increased patient costs, length of stay, and antibiotic use, particularly when caused by carbapenem-resistant bacteria. Evidence-based interventions to reduce VARI in these settings are urgently needed.

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Dataset Information

Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam.

Introduction

Methods

Results

Conclusions

Publications

Excess direct hospital cost of treating adult patients with ventilator associated respiratory infection (VARI) in Vietnam.

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