Background: Nosocomial pneumonia and especially ventilator-associated pneumonia (VAP)
are costly complications for the hospitalized patient. Nosocomial pneumonia has been estimated
to cost $5,000 per episode, but the specific cost for a VAP has not been well estimated.
As part of a successful performance improvement program in decreasing VAP from 10
VAPs/100 ICU admissions to 2.5 VAPs/100 ICU admissions, we examined the costs associated
with VAP.
Methods: From January 1, 2002, through September 30, 2003, Shock Trauma Intensive Care
Unit patients and charts were reviewed concurrently by an infection control practitioner for
development of VAP as defined by National Nosocomial Infection Surveillance (NNIS) guidelines.
Costs were obtained from the hospital's cost accounting software Transition Systems
version 3.1.01 (TSI). All patients requiring greater than one day of mechanical ventilation were
evaluated. Seventy patients with VAP and 70 patients without VAP were matched according
to age and Injury Severity Score. Differences were compared using Kruskal-Wallis and twosample
T-tests. Significance was considered for p < 0.05.
Results: The ICU cost difference was significant (p < 0.05) between the case-controlled patients
with VAP ($82,195) and those without VAP ($25,037). There was also a significant increase
in ICU length of stay (21.6 versus 6.4 days) and the number of ventilator days (17.7 versus
5.8; both, p < 0.05). Mortality was not different in the case-controlled population. A
substantial portion of the increased cost of a VAP was from the increase in ICU length of stay
($1,861/day). Pharmacy, respiratory and "other" also accounted for the increases when cost
distribution was analyzed. This translates into a cost avoidance of approximately $428,685 per
100 admissions to the ICU.
Conclusions: Ventilator-associated pneumonia not only leads to a significant increase in
ventilator days and ICU length of stay, but adds substantially to hospital costs. In our ICU,
an episode of VAP costs $57,000 per occurrence.
