Colin R Cooke1, Jeremy M Kahn2, Timothy R Watkins3, Leonard D Hudson3, Gordon D Rubenfeld4. 1. Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: crcooke@u.washington.edu. 2. Division of Pulmonary, Allergy & Critical Care, University of Pennsylvania, Philadelphia, PA. 3. Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 4. Interdepartmental Division of Critical Care, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
Abstract
BACKGROUND: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. METHODS: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. RESULTS: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were $22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90% was $9,482. Results were robust to a wide range of economic and patient parameter assumptions. CONCLUSIONS: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.
BACKGROUND: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. METHODS: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. RESULTS: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were $22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90% was $9,482. Results were robust to a wide range of economic and patient parameter assumptions. CONCLUSIONS: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.
Authors: Jeremy Grimshaw; Martin Eccles; Ruth Thomas; Graeme MacLennan; Craig Ramsay; Cynthia Fraser; Luke Vale Journal: J Gen Intern Med Date: 2006-02 Impact factor: 5.128
Authors: Angela M Cheung; Catherine M Tansey; George Tomlinson; Natalia Diaz-Granados; Andrea Matté; Aiala Barr; Sangeeta Mehta; C David Mazer; Cameron B Guest; Thomas E Stewart; Fatma Al-Saidi; Andrew B Cooper; Deborah Cook; Arthur S Slutsky; Margaret S Herridge Journal: Am J Respir Crit Care Med Date: 2006-06-08 Impact factor: 21.405
Authors: Herbert P Wiedemann; Arthur P Wheeler; Gordon R Bernard; B Taylor Thompson; Douglas Hayden; Ben deBoisblanc; Alfred F Connors; R Duncan Hite; Andrea L Harabin Journal: N Engl J Med Date: 2006-05-21 Impact factor: 91.245
Authors: Ravi Kalhan; Mark Mikkelsen; Pali Dedhiya; Jason Christie; Christine Gaughan; Paul N Lanken; Barbara Finkel; Robert Gallop; Barry D Fuchs Journal: Crit Care Med Date: 2006-02 Impact factor: 7.598
Authors: Amy E Morris; Renee D Stapleton; Gordon D Rubenfeld; Leonard D Hudson; Ellen Caldwell; Kenneth P Steinberg Journal: Chest Date: 2007-02 Impact factor: 9.410
Authors: Gordon D Rubenfeld; Ellen Caldwell; Eve Peabody; Jim Weaver; Diane P Martin; Margaret Neff; Eric J Stern; Leonard D Hudson Journal: N Engl J Med Date: 2005-10-20 Impact factor: 91.245
Authors: C J Clancy; S M Bartsch; M H Nguyen; D R Stuckey; R K Shields; B Y Lee Journal: Eur J Clin Microbiol Infect Dis Date: 2014-02-07 Impact factor: 3.267
Authors: Dharmvir S Jaswal; Janice M Leung; Junfeng Sun; Xizhong Cui; Yan Li; Steven Kern; Judith Welsh; Charles Natanson; Peter Q Eichacker Journal: Crit Care Med Date: 2014-10 Impact factor: 7.598
Authors: S M McGlone; R R Bailey; S M Zimmer; M J Popovich; Y Tian; P Ufberg; R R Muder; B Y Lee Journal: Clin Microbiol Infect Date: 2011-06-10 Impact factor: 8.067
Authors: Alex W Farnand; Alison J Eastman; Raquel Herrero; Josiah F Hanson; Steve Mongovin; William A Altemeier; Gustavo Matute-Bello Journal: Am J Respir Cell Mol Biol Date: 2011-01-21 Impact factor: 6.914
Authors: Bruce Y Lee; Sarah M McGlone; Yohei Doi; Rachel R Bailey; Lee H Harrison Journal: Infect Control Hosp Epidemiol Date: 2010-10 Impact factor: 3.254
Authors: Carolyn S Calfee; Michael A Matthay; Kirsten N Kangelaris; Edward D Siew; David R Janz; Gordon R Bernard; Addison K May; Peyton Jacob; Christopher Havel; Neal L Benowitz; Lorraine B Ware Journal: Crit Care Med Date: 2015-09 Impact factor: 7.598