The Ispor Scientific Presentations Database

ISPOR 22nd Annual International Meeting
Boston, MA, USA
May, 2017
Neurological Disorders-all, Multiple Diseases/No Specific Disease
Health Care Use & Policy Studies (HP)
Health Care Expenditure (HE)
Corral M1, Ferko N2, Andrade A2, Hollmann S2
1C.R. Bard Inc., Murray Hill, ON, Canada, 2Cornerstone Research Group Inc., Burlington, ON, Canada
OBJECTIVES: Thermoregulatory mechanisms are often disrupted in patients with critical neurological injury (CNI), leading to increased complications and resource use. Previous studies indicated early initiation of targeted temperature management (TTM) was associated with improved survival and neurologic outcomes. A structured literature review was performed to identify the economic burden associated with temperature dysregulation. The assumed costs associated with temperature dysregulation included potential cooling procedures, hospital length of stay (LOS), rehabilitation, and labor costs. METHODS:  Published studies in English, indexed on Medline, were reviewed in December 2016 (without date restriction). The search strategy included the key words “temperature management” or “therapeutic hypothermia” plus terms including but not limited to: (1) “fever”, “cardiac arrest”, “hypoxic-ischemic encephalopathy”, “stroke”, “intracerebral hemorrhage”, “Glasgow coma scale”, “cerebral performance category”, “traumatic brain injury”, “subarachnoid hemorrhage”, or “cerebral injury”, and (2) “cost”, “economic”, “nursing care”, “reimbursement”, “resource”, “societal”, or “labor”, including MeSH terms. Additional references were obtained through bibliographies. RESULTS:  Over 2000 titles and abstracts were screened, 146 studies were considered potentially relevant (including clinical and/or economic outcomes), and a subset focused on costs, resource use, or public health/economic impact. In patients with CNI, fever indicated poor prognosis, and was associated with increased LOS, mortality, and costs. However, outcomes and costs varied depending on region, definition, perspective, neurological status, and disease state. For example, reported LOS ranged from 2.5-35 days. Cost effectiveness analyses (CEAs) in patients with cardiac arrest and hypoxic ischemic encephalopathy demonstrated TTM methods have ICERs below common willingness-to-pay thresholds. CONCLUSIONS: Temperature dysregulation in CNI represents a substantial economic burden on society and the healthcare system. Several studies reported clinical benefits with TTM and may have implications for long-term cost-savings. CEAs including short- and long-term parameters also demonstrated TTM is cost-effective. Further research quantifying the long-term economics of temperature dysregulation and how temperature regulation methods can avert these is warranted.