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Is protocolised weaning that includes early extubation onto non-invasive ventilation more cost effective than protocolised weaning without non-invasive ventilation? Findings from the Breathe Study
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Breathe collaborators (Including: Khan, Iftekhar, Maredza, Mandy, Dritsaki, Melina, Mistry, Dipesh, Lall, Ranjit, Lamb, Sally, Couper, Keith, Gates, Simon, Perkins, Gavin D. and Petrou, Stavros). (2020) Is protocolised weaning that includes early extubation onto non-invasive ventilation more cost effective than protocolised weaning without non-invasive ventilation? Findings from the Breathe Study. PharmacoEconomics - Open, 4 . pp. 697-710. doi:10.1007/s41669-020-00210-1
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WRAP-Is-protocolised-weaning-extubation-ventilation-invasive-Lamb-2020.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (1819Kb) | Preview |
Official URL: http://dx.doi.org/10.1007/s41669-020-00210-1
Abstract
Background
Optimising techniques to wean patients from invasive mechanical ventilation (IMV) remains a key goal of intensive care practice. The use of non-invasive ventilation (NIV) as a weaning strategy (transitioning patients who are difficult to wean to early NIV) may reduce mortality, ventilator-associated pneumonia and intensive care unit (ICU) length of stay.
Objectives
Our objectives were to determine the cost effectiveness of protocolised weaning, including early extubation onto NIV, compared with weaning without NIV in a UK National Health Service setting.
Methods
We conducted an economic evaluation alongside a multicentre randomised controlled trial. Patients were randomised to either protocol-directed weaning from mechanical ventilation or ongoing IMV with daily spontaneous breathing trials. The primary efficacy outcome was time to liberation from ventilation. Bivariate regression of costs and quality-adjusted life-years (QALYs) provided estimates of the incremental cost per QALY and incremental net monetary benefit (INMB) overall and for subgroups [presence/absence of chronic obstructive pulmonary disease (COPD) and operative status]. Long-term cost effectiveness was determined through extrapolation of survival curves using flexible parametric modelling.
Results
NIV was associated with a mean INMB of £620 ($US885) (cost-effectiveness threshold of £20,000 per QALY) with a corresponding probability of 58% that NIV is cost effective. The probability that NIV is cost effective was higher for those with COPD (84%). NIV was cost effective over 5 years, with an estimated incremental cost-effectiveness ratio of £4618 ($US6594 per QALY gained).
Conclusions
The probability of NIV being cost effective relative to weaning without NIV ranged between 57 and 59% overall and between 82 and 87% for the COPD subgroup.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RJ Pediatrics T Technology > TH Building construction |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Ventilation, Infants -- Weaning, Pneumonia -- Prevention, Intensive care units | ||||||||
| Journal or Publication Title: | PharmacoEconomics - Open | ||||||||
| Publisher: | Springer | ||||||||
| ISSN: | 2509-4262 | ||||||||
| Official Date: | December 2020 | ||||||||
| Dates: |
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| Volume: | 4 | ||||||||
| Page Range: | pp. 697-710 | ||||||||
| DOI: | 10.1007/s41669-020-00210-1 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
| Copyright Holders: | © The Author(s) 2020 | ||||||||
| RIOXX Funder/Project Grant: |
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