Abstract
Background: Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Here, the cost effectiveness of proportional assist ventilation (PAV™ ventilation by Medtronic) is estimated relative to pressure support ventilation (PSV).Methods: A cohort-level, clinical model was built using data from clinical trials. The model estimates patient-ventilator asynchrony >10%, tracheostomy, ventilator-associated pneumonia, other nosocomial infections, spontaneous breathing trial success, hypoxemia, and death. Cost and quality of life are associated with all events, with cost effectiveness defined as the cost per quality-adjusted life year (QALY) gained in the US and UK.Results: The mean cost of ICU care was lower with PAV™ than with PSV in the US and UK, but the total cost of care over 40 years was higher due to more patients surviving and incurring future care costs. Reduced time on mechanical ventilation, fewer nosocomial infections, and extended life expectancy with PAV™ drove QALY improvement. The cost per QALY gained with PAV™ was $8,628 and £2,985.Conclusion: PAV™ improves quality of life and reduces short-term costs. PAV™ is likely to be considered cost-effective over 40-years in the US and UK.
Highlights
Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU)
The analysis described here explores the question of cost-effectiveness using a computational model of the patient care pathway and is applied to the United States (US) and United Kingdom (UK) settings
Searches of PubMed were performed on January 5, 2017 to identify recent data related to the critical care setting, healthcare costs, quality of life utilities, and efficacy and safety of pressure support ventilation (PSV) and PAVTM
Summary
Mechanical ventilation is an integral, but expensive, part of the intensive care unit (ICU). Optimal use of mechanical ventilation could save costs and improve patient outcomes. Mechanical ventilation via an endotracheal tube, is life-saving for patients with acute respiratory failure in the intensive care unit (ICU). As the most widely used supportive technique in the ICU [1], its patient benefit is generally accepted. It is, an invasive and expensive intervention. Uncomplicated mechanical ventilation in the US was found to have a mean cost of $59,770 per patient in 2009 USD [2]. The patient impact cannot be ignored, with studies showing that patients in critical care have a
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