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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

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Official URL: https://doi.org/10.1016/j.athoracsur.2018.03.058

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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
Alternative Title:
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Medicine > Warwick Medical School
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:
DateEvent
September 2018Published
27 April 2018Available
20 March 2018Accepted
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
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDQualitech HealthcareUNSPECIFIED
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