A preliminary cost-effectiveness analysis of lung protective ventilation with extra corporeal carbon dioxide removal (ECCO2R) in the management of acute respiratory distress syndrome (ARDS).
A preliminary cost-effectiveness analysis of lung protective ventilation with extra corporeal carbon dioxide removal ECCO2R in the management of acute respiratory distress syndrome ARDS.pdf
Acute respiratory distress syndrome (ARDS); Cost-effectiveness; Extra corporeal carbon dioxide removal (ECCO2R); Lung protective ventilation; Carbon Dioxide; Cost-Benefit Analysis; Humans; Lung; Respiration, Artificial; Respiratory Distress Syndrome/therapy; Respiratory Distress Syndrome; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] BACKGROUND: Mechanical ventilation (MV) is the cornerstone in the management of the acute respiratory distress syndrome (ARDS). Recent research suggests that decreasing the intensity of MV using lung protective ventilation (LPV) with lower tidal volume (Vt) and driving pressure (∆P) could improve survival. Extra-corporal CO2 removal (ECCO2R) precisely enables LPV by allowing lower Vt, ∆P and mechanical power while maintaining PaCO2 within a physiologic range. This study evaluates the potential cost-effectiveness of ECCO2R-enabled LPV in France.
METHODS: We modelled the distribution over time of ventilated ARDS patients across 3 health-states (alive & ventilated, alive & weaned from ventilation, dead). We compared the outcomes of 3 strategies: MV (no ECCO2R), LPV (ECCO2R when PaCO2 > 55 mmHg) and Ultra-LPV (ECCO2R for all). Patients characteristics, ventilation settings, survival and lengths of stay were derived from a large ARDS epidemiology study. Survival benefits associated with lower ∆P were taken from the analysis of more than 3000 patients enrolled in 9 randomized trials. Health outcomes were expressed in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were computed with both Day 60 cost and Lifetime cost.
RESULTS: Both LPV and ULPV as enabled by ECCO2R provided favorable results at Day 60 as compared to MV. Survival rates were increased with the protective strategies, notably with ULPV that provided even more manifest benefits as compared to MV. LPV and ULPV produced +0.162 and + 0.627 incremental QALYs as compared to MV, respectively. LPV and ULPV costs were augmented because of their survival benefits. Nonetheless, ICERs of LPV and ULPV vs. MV were all well below the €50,000 threshold. ULPV also presented with favorable ICERs as compared to LPV (i.e. less than €25,000/QALY).
CONCLUSIONS: ECCO2R-enabled LPV strategies might provide cost-effective survival benefit. Additional data from interventional and observational studies are needed to support this preliminary model-based analysis.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Ethgen, Oliver; SERFAN Innovation, Namur, Belgium, Department of Public Health, Epidemiology & Health Economics, University of Liège, Liège, Belgium. Electronic address: o.ethgen@uliege.be
Goldstein, Jacques; Baxter World Trade SPRL, Braine l'Alleud, Belgium
Harenski, Kai; Baxter Healthcare Corporation, Deerfield, IL, USA
Mekontso Dessap, Armand; UPEC, Institut Mondor de Recherche Biomédicale, Groupe de Recherche Clinique CARMAS, Créteil F-94010, France, APHP, Hôpitaux Universitaires Henri Mondor, Service de Médecine Intensive Réanimation, Créteil F-94010, France
Morimont, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Quintel, Michael; Department of Anaesthesia and Intensive Care Medicine, University of Göttingen Medical Center Von-Siebold-Straße 3, 37075 Göttingen, Germany
Combes, Alain; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardio Metabolism and Nutrition, F-75013 Paris, France, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France
Language :
English
Title :
A preliminary cost-effectiveness analysis of lung protective ventilation with extra corporeal carbon dioxide removal (ECCO2R) in the management of acute respiratory distress syndrome (ARDS).
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