What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis-Reference-Cited by-同舟云学术

What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis

Published:2024-06 Issue:6 Volume:6 Page:e1098
ISSN:2639-8028
Container-title:Critical Care Explorations
language:en
Short-container-title:

Author:

Yarnell Christopher J.¹²³⁴,Barrett Kali¹⁴⁵,Heath Anna⁶⁷⁸,Herridge Margaret¹⁵⁹,Fowler Robert A.¹⁴⁹¹⁰¹¹,Sung Lillian⁴¹²,Naimark David M.⁴⁹¹³,Tomlinson George⁴¹⁴

Affiliation:

1. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

2. Department of Critical Care Medicine, Scarborough Health Network, Toronto, ON, Canada.

3. Scarborough Health Network Research Institute, Toronto, ON, Canada.

4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

5. Department of Medicine, Division of Respirology, University Health Network and Sinai Health System, Toronto, ON, Canada.

6. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.

7. Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

8. Department of Statistical Science, University College London, London, United Kingdom.

9. Department of Medicine, University of Toronto, Toronto, ON, Canada.

10. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.

11. Sunnybrook Health Sciences Centre, Department of Medicine and Department of Critical Care Medicine, Toronto, ON, Canada.

12. Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.

13. Sunnybrook Health Sciences Centre, Department of Medicine, Division of Nephrology, Toronto, ON, Canada.

14. Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada.

Abstract

OBJECTIVES: To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure. PERSPECTIVE: Publicly funded healthcare payer. SETTING: Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice. METHODS: We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year. RESULTS: In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios. CONCLUSIONS: It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.

Funder

CIHR

Publisher

Ovid Technologies (Wolters Kluwer Health)

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