Background: Both Hospital-Acquired and Ventilator-Associated Pneumonia (HAP and VAP) cause considerable health care costs, as well as significantly impacting patient outcomes. The United Kingdom’s (UK’s) National Institute for Health Research-funded INHALE (https://www.ucl.ac.uk/inhale-project/) programme is exploring the use of rapid molecular diagnostics to improve the treatment of HAP/VAP patients by more swiftly identifying causative pathogens and their antibiotic resistances. Resulting changes to patient management and antibiotic use potentially have substantial resource implications, and it is important to be able to quantify these. Accordingly, to establish a baseline, a cross-sectional health economic survey of recent HAP/VAP was undertaken.
Materials/methods: Patients, or their representatives, from four UK hospital Intensive Care Units (ICUs) were approached for involvement if they were either i) starting a course of antibiotics or ii) having a change of antibiotics for the treatment of HAP or VAP. We collected information to allow estimates of: cost of ICU stay [length of stay (LOS) and related health resource group (HRG)]; acquisition cost (from the British National Formulary) of antibiotics used in the 21-days after recruitment; and quality of life (EuroQoL EQ-5D-5L) in those alive at 21-days.
Results: N=143 patients were recruited. They had considerable ICU-associated LOS and hospital costs: their mean stay was 22 days and mean costs were GBP £43,100. Both LOS and costs were heavily right-skewed (most values are low but the remainder take large values resulting in a long right ‘tail’ such that the mean is greater than the median). Compared with HAP, VAP caused greater LOS and ICU costs. Antibiotics themselves formed only a tiny fraction of total costs (mean 21-day cost was £321). A total of 43 people completed the EQ-5D-5L: a wide ranges of utilities resulted, ranging from 0.8 to -0.4 (with negatives indicating states valued worse than death).
Conclusions: HAP, and particularly VAP, are associated with significant hospital costs. Interventions that could improve the care of individuals with HAP/VAP and reduce their LOS would significantly free up scarce ICU resources, allowing other patients to be treated.