Ventilator-associated events cost in intensive care units patients with mechanical ventilation

OBJECTIVE Estimating the direct additional cost of ventilator -associated events (VAE) in intensive care units (ICU) patients. METHOD A case -control study was performed in four ICUs of Attica from 1.1.2018 to 31.12.2019. Each patient with VAE was matched to a control without VAE, based on the following variables: Duration of mechanical ventilation of controls equal to duration of mechanical ventilation of patients until occurrence of VAE +/- 20% (5 points), hospitalization in the same hospital (5 points), age +/- 5 years (4 points), Charlson score on admission +/- 2 (4 points) and gender (2 points). Pairs with a score of 20/20 were included in the final sample. Direct ICU hospitalization cost was the sum of fixed and variable cost based on a micro -costing technique. The median direct additional cost of VAE was the difference between the median direct cost of patients with VAE and that of patients without VAE. The total direct additional cost of VAEs over the two-year period was calculated by multiplying the number of patients with VAE by the median direct additional cost per VAE. RESULTS A total of 500 patients were hospitalized for >= 4 days on mechanical ventilation for 12,624 patient -days. The mean incidence of VAEs was 20.49 episodes/1,000 ventilator days. After matching, 165 patient -control pairs were included in the final analysis. In patients with VAE, the median additional length of stay was 13 days and the median additional duration of mechanical ventilation was 12 days, while mortality was twice as high as in patients without VAE (p<0.05). The median direct additional cost per VAE episode was (sic) 7,217.1. By direct cost category, the median additional fixed cost per VAE episode was (sic) 1,832.2, while the median additional variable cost per VAE episode was (sic) 5,426.1. Regarding the additional variable cost subcategories, the highest median cost was for antibiotics ((sic) 3,327.4). The total direct additional cost over the two-year period was (sic) 1,190,821.5 for the total of 165 VAE episodes. CONCLUSIONS Our findings highlight the real economic impact of VAEs and emphasize the need to implement prevention bundle to reduce the burden of VAEs, increase the number of available ICU beds and improve ICU safety and quality of care.