Cost Analysis of Noninvasive Helmet Ventilation Compared with Use of Noninvasive Face Mask in ARDS.

Kwadwo Kyeremanteng,Raphaëlle Robidoux,Daniel Kobewka,Louis-Philippe Gagnon,Dipayan Chaudhuri,Kednapa Thavorn,John P Kress

doi:10.1155/2018/6518572

Abstract

Intensive care unit (ICU) costs have doubled since 2000, totalling 108 billion dollars per year. Acute respiratory distress syndrome (ARDS) has a prevalence of 10.4% and a 28-day mortality of 34.8%. Noninvasive ventilation (NIV) is used in up to 30% of cases. A recent randomized controlled trial by Patel et al. (2016) showed lower intubation rates and 90-day mortality when comparing helmet to face mask NIV in ARDS. The population in the Patel et al. trial was used for cost analysis in this study. Projections of cost savings showed a decrease in ICU costs by $2527 and hospital costs by $3103 per patient, along with a 43.3% absolute reduction in intubation rates. Sensitivity analysis showed consistent cost reductions. Projected annual cost savings, assuming the current prevalence of ARDS, were $237538 in ICU costs and $291682 in hospital costs. At a national level, using yearly incidence of ARDS cases in American ICUs, this represents $449 million in savings. Helmet NIV, compared to face mask NIV, in nonintubated patients with ARDS, reduces ICU and hospital direct-variable costs along with intubation rates, LOS, and mortality. A large-scale cost-effectiveness analysis is needed to validate the findings.

Highlights

Our population is aging, hospital admissions are getting more frequent with a longer length of stay (LOS), intensive care and hospital occupancy rates are climbing, and healthcare-associated expenditures are increasing [1, 2]
Methods e population used to calculate intensive care unit (ICU) and hospital costs consists of patients with Acute respiratory distress syndrome (ARDS), treated with face mask or helmet Noninvasive ventilation (NIV), studied in the randomized controlled trial by Patel et al [7]. e total and individual patient costs of both study groups were calculated based on their reported ICU and hospital LOS
With a significant reduction in ICU and hospital LOS in the helmet NIV group, associated ICU and hospital costs were reduced by 2527 US dollars and 3103 US dollars per patient, respectively. e total cost saving in the care of the helmet NIV group was 71842 US dollars

Summary

Introduction

Hospital admissions are getting more frequent with a longer length of stay (LOS), intensive care and hospital occupancy rates are climbing, and healthcare-associated expenditures are increasing [1, 2]. Intensive care costs alone totalled 108 billion US dollars in 2010, nearly double that of 2000 (56 billion US dollars). ICU costs account for 13.2% of hospital expenditures and 0.72% of the gross domestic product in the United States, a 32% percent rise from 2000 to 2010 [1, 2]. It is estimated that a single day in the intensive care unit (ICU) costs 2500–4300. US dollars per patient, representing a 61.1% increase in costs over the same time period with the use of new medications, technologies, and specialized care [1,2,3,4]. Moving forward, finding ways to reduce ICU costs will reduce the financial burden of increasing utilization of ICU care. New practices focusing on cost-effectiveness will be key by evaluating the effectiveness of the practice on patient outcomes as well as the resources required to implement it [5]

Methods

Results

Conclusion