Acute respiratory distress syndrome cost-effectiveness of therapy: Difference between revisions
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{{Acute respiratory distress syndrome}} | {{Acute respiratory distress syndrome}} | ||
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==Overview== | |||
Although ARDS is a serious medical condition associated with a very high [[mortality rate]], the application of evidence-based therapies (e.g., [[Acute respiratory distress syndrome mechanical ventilation therapy#Mechanical Ventilation|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 [[Acute respiratory distress syndrome mechanical ventilation therapy#Mechanical Ventilation|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%:<ref name="pmid11099680">{{cite journal| author=Hamel MB, Phillips RS, Davis RB, Teno J, Connors AF, Desbiens N et al.| title=Outcomes and cost-effectiveness of ventilator support and aggressive care for patients with acute respiratory failure due to pneumonia or acute respiratory distress syndrome. | journal=Am J Med | year= 2000 | volume= 109 | issue= 8 | pages= 614-20 | pmid=11099680 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11099680 }} </ref> | |||
:*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 respiratory distress syndrome historical perspective|acute lung injury (ALI)]] concluded that the implementation of [[Acute respiratory distress syndrome mechanical ventilation therapy#Mechanical Ventilation|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.<ref name="pmid19318673">{{cite journal| author=Cooke CR, Kahn JM, Watkins TR, Hudson LD, Rubenfeld GD| title=Cost-effectiveness of implementing low-tidal volume ventilation in patients with acute lung injury. | journal=Chest | year= 2009 | volume= 136 | issue= 1 | pages= 79-88 | pmid=19318673 | doi=10.1378/chest.08-2123 | pmc=2716714 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19318673 }} </ref> | |||
*The CESAR trial compared conventional [[mechanical ventilation]] practices to [[extracorporeal membrane oxygenation|extracorporeal membrane oxygenation (ECMO)]] in patients with [[Acute respiratory distress syndrome diagnostic criteria|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).<ref name="pmid19762075">{{cite journal| author=Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM et al.| title=Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. | journal=Lancet | year= 2009 | volume= 374 | issue= 9698 | pages= 1351-63 | pmid=19762075 | doi=10.1016/S0140-6736(09)61069-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19762075 }} </ref> | |||
==References== | ==References== | ||
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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.