Economic evaluation of enhanced oral care in reducing the incidence of non-ventilator hospital-acquired pneumonia

Abstract

The Hospital-Acquired Pneumonia PrEveNtion (HAPPEN) trial evaluated the effectiveness and cost-effectiveness of improving oral care on reducing non-ventilator hospital-acquired pneumonia (NV-HAP). This study aimed to assess the cost-effectiveness of the HAPPEN intervention compared with usual care. The HAPPEN trial was a cluster randomised controlled trial conducted across three Australian hospitals. A within trial economic evaluation was undertaken from a hospital perspective using an intention to treat approach. Cost-effectiveness was estimated using a cohort-level decision analytic model incorporating intervention implementation costs and bed day costs associated with NV-HAP treatment. Costs were reported in 2025 Australian dollars (AUD). Health outcomes were measured in quality-adjusted life years (QALYs). Trial data and published literature informed model parameters. Outcomes were reported using net monetary benefit. Probabilistic sensitivity analysis was conducted at a willingness to pay threshold of AUD$28,000 per QALY. For a cohort of 1,000 patients, usual care were estimated at AUD$12,148,000, compared with AUD$11,996,000 for the intervention after accounting for bed days saved. These estimates corresponded to a saving of AUD$152 and 0.02 QALY gained per patient, supporting the HAPPEN intervention as dominant. A positive incremental net monetary benefit of AUD$642 (95% uncertainty interval AUD$42 to AUD$1,591) per patient indicated the intervention as a cost-effective strategy. Probabilistic sensitivity analysis showed the intervention had approximately 98% probability of being cost-effective at the AUD$28,000 willingness to pay threshold. Improved oral care in the HAPPEN trial was cost-effective, reducing NV-HAP and associated hospital costs, supporting its adoption as an infection prevention strategy.