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A Cost-Effectiveness Analysis of an Intervention to Increase the Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
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A1447 - A Cost-Effectiveness Analysis of an Intervention to Increase the Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
Author Block: C. Baston1, N. B. Coe2, C. Guerin3, S. D. Halpern4; 1Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States, 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, 3Réanimation Médicale, Hôpital de la Croix-Rousse, 69003 Lyon, France, 4Univ of Pennsylvania, Philadelphia, PA, United States.
Rationale: Randomized clinical trials and meta-analyses reveal that prone positioning reduces mortality in acute respiratory distress syndrome (ARDS), resulting in guidelines recommending the technique for moderate to severe cases. Yet only about 16% of patients meeting these criteria receive prone positioning.
Objectives: To determine the cost effectiveness of a putative intervention, such as adding an extra ICU nurse, to increase utilization of prone positioning for severe ARDS.
Methods: We created two decision trees to model severe ARDS from ICU admission through death (from a societal perspective) and through hospital discharge (from a hospital perspective). We assumed that all patients received low tidal volume ventilation. We used raw data from the PROSEVA trial for point estimates of clinical data and recent cohort studies for outpatient costs and benefits. Sepsis as an etiology for ARDS was assigned a survival penalty compared to other etiologies. In probabilistic sensitivity analyses we varied each model input from the 5th-95th percent confidence interval of its distribution. We assumed the intervention would increase utilization from 16% to 65%, approximately the current uptake of low tidal volume ventilation.
Measurements and Main Results: In the societal perspective model, the intervention accumulated an additional 0.725 (95% CI 0.095-1.534) quality-adjusted life years (QALYs) at an additional cost of $27,092 (95% CI -$827-$80,775), yielding an incremental cost-effectiveness ratio (ICER) of $37,779 per QALY (95% CI -$1,030-$91,551). If society was willing to pay $100,000 per QALY, the intervention would represent good value if it cost less than $47,790 per patient. From a hospital perspective, the intervention accumulated an additional 0.072 (95% CI 0.009-0.147) survivals-to-discharge at a cost of $1,926 (95% CI -$22,907-$29,737), for an ICER of $23,999 per extra survival (95% CI -$291,940-$380,899). If hospitals were willing to pay $100,000 per survival-to-discharge, the intervention would represent good value if it cost less than $5,140 per patient.
Conclusions: An intervention that increases utilization of prone positioning would be cost effective if it cost less than $47,790 per patient from a societal perspective or $5,140 per patient from a hospital perspective.
Author Block: C. Baston1, N. B. Coe2, C. Guerin3, S. D. Halpern4; 1Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States, 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, 3Réanimation Médicale, Hôpital de la Croix-Rousse, 69003 Lyon, France, 4Univ of Pennsylvania, Philadelphia, PA, United States.
Rationale: Randomized clinical trials and meta-analyses reveal that prone positioning reduces mortality in acute respiratory distress syndrome (ARDS), resulting in guidelines recommending the technique for moderate to severe cases. Yet only about 16% of patients meeting these criteria receive prone positioning.
Objectives: To determine the cost effectiveness of a putative intervention, such as adding an extra ICU nurse, to increase utilization of prone positioning for severe ARDS.
Methods: We created two decision trees to model severe ARDS from ICU admission through death (from a societal perspective) and through hospital discharge (from a hospital perspective). We assumed that all patients received low tidal volume ventilation. We used raw data from the PROSEVA trial for point estimates of clinical data and recent cohort studies for outpatient costs and benefits. Sepsis as an etiology for ARDS was assigned a survival penalty compared to other etiologies. In probabilistic sensitivity analyses we varied each model input from the 5th-95th percent confidence interval of its distribution. We assumed the intervention would increase utilization from 16% to 65%, approximately the current uptake of low tidal volume ventilation.
Measurements and Main Results: In the societal perspective model, the intervention accumulated an additional 0.725 (95% CI 0.095-1.534) quality-adjusted life years (QALYs) at an additional cost of $27,092 (95% CI -$827-$80,775), yielding an incremental cost-effectiveness ratio (ICER) of $37,779 per QALY (95% CI -$1,030-$91,551). If society was willing to pay $100,000 per QALY, the intervention would represent good value if it cost less than $47,790 per patient. From a hospital perspective, the intervention accumulated an additional 0.072 (95% CI 0.009-0.147) survivals-to-discharge at a cost of $1,926 (95% CI -$22,907-$29,737), for an ICER of $23,999 per extra survival (95% CI -$291,940-$380,899). If hospitals were willing to pay $100,000 per survival-to-discharge, the intervention would represent good value if it cost less than $5,140 per patient.
Conclusions: An intervention that increases utilization of prone positioning would be cost effective if it cost less than $47,790 per patient from a societal perspective or $5,140 per patient from a hospital perspective.
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