While clinicians continue to redefine ventilator-associated pneumonia (VAP), numerous innovations that claim to reduce pulmonary microaspiration and its consequences - that is, novel endotracheal cuff shapes and cuff materials, subglottic drainage, automatic cuff pressure controllers, oral anti-septics, selective digestive decontamination (SDD), and devices to combat biofilm formation within the lumen of the tracheal tube - are coming to the market [1, 2]. There are two questions that clinicians ask when deciding whether to incorporate a new product or intervention into a VAP prevention bundle. Firstly, what are its efficacy and effectiveness? In other words, what is the relative risk reduction (RRR) and therefore the number needed to treat (NNT) to prevent one additional VAP. Secondly, is this new intervention cost-effective in my local patients?

To establish whether the intervention is cost-effective, further knowledge of the cost of the intervention and the cost to treat an episode of VAP is required. A recent US study estimated the cost of VAP to be nearly $40,000 (£25,000 or €30,000) [4]. If costs are assumed to be lower in Europe, then a conservative estimate of the cost per episode of VAP would still be around £10,000, which is equivalent to an extra 7 days of intensive care unit (ICU) stay. What should we consider when assessing the cost-effectiveness of VAP prevention?

We think that this analysis might help clinicians in making the important economic decision of whether to adopt a new VAP prevention device or procedure. Our calculations can easily be adapted to local currencies and circumstances worldwide.