Acute respiratory distress syndrome cost-effectiveness of therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
Although ARDS is a serious medical condition associated with a very high mortality rate, the application of evidence-based therapies (e.g., lower tidal volume mechanical ventilation) have been shown to be cost-effective.
Cost-effectiveness of therapy
Although ICU-level care can be very costly, the use of low tidal volume mechanical ventilation appears to be cost-effective:
- One study of patients with respiratory failure due to pneumonia or ARDS concluded that mechanical ventilation was cost-effective when the probability of surviving at least 2 months following mechanical ventilation was > 50%:[1]
- When the probability of surviving at least 2 months was > 70%, the cost per quality-adjusted life year (QALY) was $29,000
- When the probability of surviving at least 2 months was 51 to 70%, the cost per QALY was $44,000
- When the probability of surviving at least 2 months was < 50%, the cost per QALY was $110,000
- One study of patients with acute lung injury (ALI) concluded that the implementation of low tidal volume mechanical ventilation (lung protective ventilation) was more cost-effective compared to other, non-lung-protective mechanical ventilation strategies, with an increase in quality-adjusted life years (QALYs) of 15% at an additional cost of $7,233 per patient treated with lung-protective ventilation.[2]
- The CESAR trial compared conventional mechanical ventilation practices to extracorporeal membrane oxygenation (ECMO) in patients with severe ARDS and calculated a QALY gain of 0.03 at a cost of £19,252 (roughly $31,000 in the year when the study was published).[3]
References
- ↑ Hamel MB, Phillips RS, Davis RB, Teno J, Connors AF, Desbiens N; et al. (2000). "Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome". Am J Med. 109 (8): 614–20. PMID 11099680.
- ↑ Cooke CR, Kahn JM, Watkins TR, Hudson LD, Rubenfeld GD (2009). "Cost-effectiveness of implementing low-tidal volume ventilation in patients with acute lung injury". Chest. 136 (1): 79–88. doi:10.1378/chest.08-2123. PMC 2716714. PMID 19318673.
- ↑ Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM; et al. (2009). "Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial". Lancet. 374 (9698): 1351–63. doi:10.1016/S0140-6736(09)61069-2. PMID 19762075.