The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome

Objectives: Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome. Design: We created decisio...

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Autores: Baston, CM, Coe, NB, Guerin, C, Mancebo, J, Halpern, S
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p2936
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2936
https://europepmc.org/articles/pmc6383780
Access Level:acceso abierto
Palabra clave:cost-benefit analysis
decision trees
prone position
respiratory distress syndrome
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spelling The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress SyndromeBaston, CMCoe, NBGuerin, CMancebo, JHalpern, Scost-benefit analysisdecision treesprone positionrespiratory distress syndromeObjectives: Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome. Design: We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI. Setting: ICUs that care for patients with acute respiratory distress syndrome. Subjects: Patients with moderate to severe acute respiratory distress syndrome. Interventions: The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning. Measurements and Main Results: In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $ 31,156 (95% CI, -$ 158 to $ 92,179) (incremental cost-effectiveness ratio = $ 38,648 per quality-adjusted life year [ 95% CI, $ 1,695$ 98,522]). If society was willing to pay $ 100,000 per qualityadjusted life year, any intervention costing less than $ 51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $ 5,242 (95% CI, -$ 19,035 to $ 41,019) (incremental cost-effectiveness ratio = $ 44,615 per extra survival [ 95% CI, -$ 250,912 to $ 558,222]). If hospitals were willing to pay $ 100,000 per survival-to-discharge, any intervention costing less than $ 5,140 per patient would represent good value. Conclusions: Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.LIPPINCOTT WILLIAMS & WILKINS2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2936https://europepmc.org/articles/pmc6383780CRITICAL CARE MEDICINEISSN: 00903493ISSNe: 15300293reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p29362026-06-14T12:41:47Z
dc.title.none.fl_str_mv The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
title The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
spellingShingle The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
Baston, CM
cost-benefit analysis
decision trees
prone position
respiratory distress syndrome
title_short The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
title_full The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
title_fullStr The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
title_full_unstemmed The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
title_sort The Cost-Effectiveness of Interventions to Increase Utilization of Prone Positioning for Severe Acute Respiratory Distress Syndrome
dc.creator.none.fl_str_mv Baston, CM
Coe, NB
Guerin, C
Mancebo, J
Halpern, S
author Baston, CM
author_facet Baston, CM
Coe, NB
Guerin, C
Mancebo, J
Halpern, S
author_role author
author2 Coe, NB
Guerin, C
Mancebo, J
Halpern, S
author2_role author
author
author
author
dc.subject.none.fl_str_mv cost-benefit analysis
decision trees
prone position
respiratory distress syndrome
topic cost-benefit analysis
decision trees
prone position
respiratory distress syndrome
description Objectives: Despite strong evidence supporting proning in acute respiratory distress syndrome, few eligible patients receive it. This study determines the cost-effectiveness of interventions to increase utilization of proning for severe acute respiratory distress syndrome. Design: We created decision trees to model severe acute respiratory distress syndrome from ICU admission through death (societal perspective) and hospital discharge (hospital perspective). We assumed patients received low tidal volume ventilation. We used short-term outcome estimates from the PROSEVA trial and longitudinal cost and benefit data from cohort studies. In probabilistic sensitivity analyses, we used distributions for each input that included the fifth to 95th percentile of its CI. Setting: ICUs that care for patients with acute respiratory distress syndrome. Subjects: Patients with moderate to severe acute respiratory distress syndrome. Interventions: The implementation of a hypothetical intervention to increase the appropriate utilization of prone positioning. Measurements and Main Results: In the societal perspective model, an intervention that increased proning utilization from 16% to 65% yielded an additional 0.779 (95% CI, 0.088-1.714) quality-adjusted life years at an additional long-term cost of $ 31,156 (95% CI, -$ 158 to $ 92,179) (incremental cost-effectiveness ratio = $ 38,648 per quality-adjusted life year [ 95% CI, $ 1,695$ 98,522]). If society was willing to pay $ 100,000 per qualityadjusted life year, any intervention costing less than $ 51,328 per patient with moderate to severe acute respiratory distress syndrome would represent good value. From a hospital perspective, the intervention yielded 0.072 (95% CI, 0.008-0.147) more survivals-to-discharge at a cost of $ 5,242 (95% CI, -$ 19,035 to $ 41,019) (incremental cost-effectiveness ratio = $ 44,615 per extra survival [ 95% CI, -$ 250,912 to $ 558,222]). If hospitals were willing to pay $ 100,000 per survival-to-discharge, any intervention costing less than $ 5,140 per patient would represent good value. Conclusions: Interventions that increase utilization of proning would be cost-effective from both societal and hospital perspectives under many plausible cost and benefit assumptions.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2936
https://europepmc.org/articles/pmc6383780
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2936
https://europepmc.org/articles/pmc6383780
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
dc.source.none.fl_str_mv CRITICAL CARE MEDICINE
ISSN: 00903493
ISSNe: 15300293
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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