COST-UTILITY ANALYSIS OF ORAL ANTISEPTIC CHLORHEXIDINE IN DECREASING VENTILATOR-ASSOCIATED PNEUMONIA IN INTENSIVE CARE UNITS

Purpose:

   Incidence of ventilator-associated pneumonia (VAP), a condition associated with reduced survival, quality of life and increased resource utilization, remains high within the intensive care unit (ICU) setting. Chlorhexidine (CHX) has been shown to reduce VAP in ICU but to increase mortality rates. This study was conducted to evaluate the cost-utility of using CHX against placebo/usual care in preventing VAP among ventilated ICU patients.

Method:

   An economic evaluation (EE) based on a state transition model was conducted. The model consisted of four health states: mechanical ventilation, VAP, discharge, and death. Daily cycles and a lifetime horizon was assumed while both costs and benefits were discounted by 5%. Costs were inflated to 2015 Canadian dollars and a third party payer perspective was adopted. The primary outcomes for this analysis were the incremental cost per life-year gained as well as the incremental cost per quality adjusted life years (QALYs) gained. CHX effectiveness was obtained from a Cochrane systematic review. Relative survival with CHX was estimated through a meta-analysis based on existing systematic reviews. The rest of the input parameters were derived from the published literature. One-way sensitivity analyses were conducted as well as a Markov-Chain, Monte-Carlo (MCMC) probabilistic analysis to incorporate uncertainty in the EE estimates.

Result:

   Use of CHX was associated with a total of 0.4 life-years or 0.3 QALYs lost. Overall, the cost savings associated with CHX were $-2,305.95 per patient. Our cost-utility analysis yielded an ICUR of $7,683/QALY and $5,191/life-years. Variations in one-way sensitivity analysis yielded similar results to the base case. Probabilistic analysis indicated that there is 0.7% that CHX results in QALY gains or that it dominates usual care.  

Conclusion:

   CHX use in ICU for preventing VAP is not cost-effective. Although CHX therapy is less costly than standard care without CHX use, it results in fewer QALY outcomes. This finding is mainly driven by the added mortality effect associated with CHX.