GM-012 Pharmacoeconomics evaluation of implementation of selective digestive tract decontamination for prevention of ventilator associated pneumonia in a critical care unit

Background Selective decontamination of the digestive tract has been proven to be the best measure to prevent ventilator associated pneumonia (VAP) and the only one that has demonstrated modest reductions in mortality. The preparations are typically non-absorbable, topical admixtures of antibiotics with broad spectrum activity administered either orally and/or enterally applied as an oropharyngeal paste (OP), or as a suspension (decontamination of the digestive tract suspension, DDS). Purpose The purpose of this study was to analyse the composition, costs of acquisition or elaboration at the pharmacy department (PD) of these preparations to determine the most cost effective option and the annual economic impact of the implementation of this new measure at the anaesthesia critical care unit (ACCU). Material and methods We conducted a literature research and analysed if the preparations could be acquired through a regular provider (A) or had to be made at the PD (B). To determine the costs if the preparations were made at the PD, we considered the total costs of raw materials, packaging materials, consumables and staff time. Results We found that antibiotics commonly used were tobramycin, colistin and anfoterincin B (or nystatin instead), and vancomycin was added in the case of methicillin resistant Staphylococcus aureus . We agreed with the ACCU for the PD to provide tobramycin, colistin and nystatin. Preparation costs/acquisition were: OP: €1.43/g A; €0.12/g B; and for DDS: €4.42/10 mL A; €0.70/10 mL B. Regarding the annual consumption, estimating the average of intubated patients per day and the dosage (10 mL DDS every 8 hours and 5 mL orally every 8 hours, equating to 4.58 g B and 1.6g A), we estimated the costs on: €1.556 if we made it and €36.234 if we acquired it. We agreed with the ACCU for the PD to provide these preparations as it may result in estimated annual saving of €24 678. Conclusion After analysing the composition, costs of acquisition or elaboration at the PD, we concluded that the elaboration of OP and DDS at the PD significantly saved costs compared with the acquisition of both preparations already commercialised. This implies optimisation of resources, one of the main objectives of healthcare management. References and/or acknowledgements Klompas M, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol2014;35:S133–54. No conflict of interest