OBJECTIVES

Mechanical ventilation in the intensive care unit (ICU) increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injuries (PrI). Beds with continuous lateral rotation therapy (CLRT) are shown to reduce HAC incidence, but the value of switching to CLRT beds is presently unknown. We compared the cost-effectiveness of CLRT beds to standard care at the willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY) saved and calculated the return on investment (ROI) of its implementation.

METHODS

A Markov model was constructed to predict health state transitions from the time of ventilation through 28 days using the healthcare sector perspective. Daily transition probabilities were extrapolated from prospective clinical studies comparing CLRT with standard care. Costs were estimated in 2014 USD. QALYs were extracted from the published literature. Results were interpreted as incremental cost per QALY. Univariate and multivariate probabilistic sensitivity analysis with 10,000 Monte Carlo simulations tested model uncertainty. ROI estimated the breakeven point of the investment. Expected value of perfect information (EVPI) was used to determine whether further research was warranted based on uncertainty.

RESULTS

Our analysis suggested that CLRT beds dominated standard care. From the healthcare sector perspective, expected cost for CLRT was $47,165/patient compared to a higher cost of $49,258/patient for standard care. The expected effectiveness of CLRT 0.0418 QALYs/patient compared to 0.0416 QALYs/patient for standard care. While the QALYs were nearly equal, our deterministic model confirms that CLRT beds technically dominate standard care. CLRT dominated standard care in 99.94% of Monte Carlo simulations. Health systems could expect to achieve an ROI for CLRT in 5 months. EVPI indicated little value of additional evidence collection based on current parameter uncertainty.

CONCLUSIONS

CLRT is highly cost-effective compared to standard care by preventing VAP and HACs. Hospitals may save on upfront investments in CLRT beds.