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Is the Venner-PneuX endotracheal tube system a cost-effective option for post cardiac surgery care?
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Andronis, L. (Lazaros), Oppong, Raymond A., Manga, Na’ngono, Senanayake, Eshan, Gopal, Shameer, Charman , Susan, Giri, Ramesh and Luckraz, Heyman (2018) Is the Venner-PneuX endotracheal tube system a cost-effective option for post cardiac surgery care? The Annals of Thoracic Surgery, 106 (3). pp. 757-763. doi:10.1016/j.athoracsur.2018.03.058 ISSN 0003-4975.
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WRAP-Venner-PneuX-endotracheal-tube-system-Andronis-2018.pdf - Accepted Version - Requires a PDF viewer. Download (1154Kb) | Preview |
Official URL: https://doi.org/10.1016/j.athoracsur.2018.03.058
Abstract
Background
Ventilator-associated pneumonia (VAP) is common and costly. In a recent randomized controlled trial, the Venner-PneuX (VPX) endotracheal tube system was found to be superior to standard endotracheal tubes (SET) in preventing VAP. However, VPX is considerably more expensive. We evaluated the costs and benefits of VPX to determine whether replacing SET with VPX is a cost-effective option for intensive care units.
Methods
We developed a decision analytic model to compare intubation with VPX or SET for patients requiring mechanical ventilation post cardiac surgery. The model was populated with existing evidence on costs, effectiveness and quality of life. Cost-effectiveness and cost-utility analyses were conducted from an NHS hospital perspective. Uncertainty was assessed through deterministic and probabilistic sensitivity analyses.
Results
Compared to SET, VPX is associated with an expected cost saving of £738 per patient. VPX led to a small increase in quality-adjusted life years (QALYs), indicating that the device is overall less costly and more effective than SET. The probability of VPX being cost-effective at £30,000 per QALY is 97%. VPX would cease to be cost-effective if (i) it led to a risk reduction smaller than 0.02 compared to SET, (ii) the acquisition cost of VPX was as high as £890 or, (iii) the cost of treating a case of VAP was lower than £1,450.
Conclusions
VPX resulted in improved outcomes and savings which far offset the cost of the device, suggesting that replacing SET with VPX is overall beneficial. Findings were robust to extreme values of key parameters.
| Item Type: | Journal Article | ||||||||
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| Alternative Title: | |||||||||
| Subjects: | R Medicine > RD Surgery | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Heart -- Surgery -- Instruments, Pneumonia, Respirators (Medical equipment) | ||||||||
| Journal or Publication Title: | The Annals of Thoracic Surgery | ||||||||
| Publisher: | Elsevier Inc. | ||||||||
| ISSN: | 0003-4975 | ||||||||
| Official Date: | September 2018 | ||||||||
| Dates: |
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| Volume: | 106 | ||||||||
| Number: | 3 | ||||||||
| Page Range: | pp. 757-763 | ||||||||
| DOI: | 10.1016/j.athoracsur.2018.03.058 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
| Date of first compliant deposit: | 20 March 2018 | ||||||||
| Date of first compliant Open Access: | 27 April 2019 | ||||||||
| RIOXX Funder/Project Grant: |
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