The impact of ventilator-associated pneumonia on the Canadian health care system B John G. Muscedere MD a , Claudio M. Martin MD b , Daren K. Heyland MD, MSc a, ⁎ a Queens University, Kingston, Canada K7L 2V7 b University of Western Ontario, Ontario, Canada N6A 4G5 Keywords: Ventilator-associated pneumonia; Nosocomial infections; Canadian health care system Abstract Introduction: Ventilator-associated pneumonia (VAP) is a cause of morbidity and mortality in critically ill patients. It is associated with increased health care costs and duration of mechanical ventilation. Using published data and information from public health care providers, we sought to determine the impact of VAP on the Canadian health care system. Methods: Ventilator-associated pneumonia incidence, attributable mortality, and intensive care unit (ICU) utilization/resource data were obtained through Canadian published and institutional data. Ontario case cost methodology was used for the cost of a critical care bed which is CAN$2396 per day, excluding treatment costs. Antibiotic acquisition costs for Ontario were used. Physician reimbursement rates were obtained from the provincial ministries of health. Ventilator-associated pneumonia data, ICU resource data, and costs were combined to determine the impact of VAP. Results: For the Canadian health care system; ICU utilization is 217 episodes per 100 000 population and 1150 days of mechanical ventilation per 100000. The incidence of VAP is 10.6 cases per 1000 ventilator days (95% CI, 5.1-16.1). Ventilator-associated pneumonia increases ICU length of stay 4.3 days (95% CI, 1.5-7.0 days) per episode. The attributable mortality of VAP is 5.8% (95% CI, -2.4 to 14). The number of cases of VAP is estimated to be approximately 4000 cases per year (95% CI, 1900- 6100). This results in 230 deaths per year with the lower and upper confidence intervals ranging from 0 to 580. Ventilator-associated pneumonia accounts for approximately 17000 ICU days per year or around 2% of all ICU days in Canada. The cost to the health care system is CAN$46 million (possible range, $10 million to 82 million) per year. Conclusion: The impact of VAP on the Canadian health care system is considerable. Eradication of this preventable nosocomial infection would save lives and conserve scarce health care resources. © 2008 Elsevier Inc. All rights reserved. 1. Introduction Nosocomial infections are an important cause of morbidity and mortality in hospitalized patients and are associated with increased health care costs [1]. Hospital acquired pneumonia is the second most common nosocomial infection after urinary ☆ Conflicts of interest: J Muscedere and D Heyland have received unrestricted research grants for studies in VAP unrelated to the present manuscript from Astra-Zeneca and Bayer Pharmaceuticals. ⁎ Corresponding author. Tel.: +1 613 549 6666#3339; fax: +1 613 548 1351. E-mail address: dkh2@queensu.ca (D.K. Heyland). 0883-9441/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jcrc.2007.11.012 Journal of Critical Care (2008) 23,5–10