1 Division of Infectious Diseases, Department of Medicine, Eastern Colorado VA Healthcare System and University of Colorado School of Medicine, Denver, Colorado.
2 Division of Infectious Diseases, Department of Medicine, and.
Am J Respir Crit Care Med. 2015 Jul 1;192(1):57-63. doi: 10.1164/rccm.201412-2316OC.
Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection with high associated cost and poor patient outcomes. Many strategies for VAP reduction have been evaluated. However, the combination of strategies with the optimal cost-benefit ratio remains unknown.
To determine the preferred VAP prevention strategy, both from the hospital and societal perspectives.
A cost-benefit decision model with a Markov model was constructed. Baseline probability of VAP, death, reintubation, and discharge from the intensive care unit (ICU) alive were ascertained from clinical trial data. Model inputs were obtained from the medical literature and the U.S. Department of Labor; a device cost was obtained from the manufacturer. Sensitivity analyses were completed to test the robustness of model results.
Overall least expensive strategy and the strategy with the best cost-benefit ratio, up to a willingness to pay threshold of $50,000-100,000 per case of VAP averted was sought. We examined a total of 120 unique combinations of VAP prevention strategies. The preferred strategy from the hospital perspective included subglottic suction endotracheal tubes, probiotics, and the Institute for Healthcare Improvement VAP Prevention Bundle. The preferred strategy from the point of view of society also included additional prevention measures (oral care with chlorhexidine and selective oral decontamination). No preferred strategies included silver endotracheal tubes or selective gut decontamination.
Despite their infrequent use, current data suggest that the use of prophylactic probiotics and subglottic endotracheal tubes are cost-effective for preventing VAP from the societal and hospital perspectives.
呼吸机相关性肺炎（VAP）是一种常见的医院获得性感染，与高昂的费用和较差的患者预后相关。许多减少 VAP 的策略已经得到评估。然而，具有最佳成本效益比的策略组合仍不清楚。
从医院和社会角度确定首选的 VAP 预防策略。
构建了一个成本效益决策模型，采用马尔可夫模型。VAP、死亡、重新插管和从重症监护病房（ICU）存活出院的基础概率从临床试验数据中确定。模型输入从医学文献和美国劳工部获得；设备成本从制造商处获得。进行了敏感性分析以测试模型结果的稳健性。
寻求总体上最便宜的策略和具有最佳成本效益比的策略，直至达到每例 VAP 预防的支付意愿阈值为 50,000-100,000 美元。我们总共检查了 120 种独特的 VAP 预防策略组合。从医院角度来看，首选策略包括声门下吸引气管内管、益生菌和改善医疗保健研究所（IHI）VAP 预防套餐。从社会角度来看，首选策略还包括其他预防措施（氯己定口腔护理和选择性口腔去污）。没有首选策略包括银气管内管或选择性肠道去污。
尽管它们的使用频率较低，但现有数据表明，预防性使用益生菌和声门下气管内管从社会和医院的角度来看，预防 VAP 是具有成本效益的。
