THE VALUE OF BEDS WITH CONTINUOUS LATERAL ROTATION THERAPY TO PREVENT VENTILATOR-ASSOCIATED PNEUMONIA AND PRESSURE INJURIES- A COST-EFFECTIVENESS ANALYSIS
Author(s)
Kang S, DiStefano MJ, Yehia F, Luthra K, Waters D, Padula WV
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
OBJECTIVES: Immobility of mechanically ventilated patients in the intensive care unit (ICU) increases the risk of pulmonary complications and hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injuries (PrI). Continuous lateral rotation therapy (CLRT) has been shown to reduce the incidence of VAP and PrI, but the economic value of switching to CLRT over standard care is presently unknown. The objective of this study is to evaluate the cost-effectiveness of CLRT specialty beds compared to standard care in ICUs and to determine the return on investment (ROI) associated with its implementation. METHODS: A Markov model was constructed to predict health state transition 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. Utility scores were extracted from the published literature. Cost per quality-adjusted life-years (QALYs) was calculated, and probabilistic sensitivity analyses (PSA) using 10,000 Monte Carlo simulations were conducted. ROI analysis was also performed to estimate the net benefit and breakeven point of the investment. RESULTS: CLRT was dominant over standard care. The expected cost for a CLRT per patient was $47,140 compared to standard care at $49,229 per patient, showing that CLRT saves cost per patient. The expected effectiveness of CLRT per patient was 0.0454 QALYs compared to 0.0451 QALYs for standard care. CLRT was dominant in 99.94% of the Monte Carlo simulations in the PSAs and 100% of the simulations in the univariate sensitivity analysis. CLRT also showed outstanding ROI reaching the breaking even point after 0.42 of a year. CONCLUSIONS: CLRT appears to be highly cost-effective compared to standard care by preventing ventilator-associated infections and PrIs in an ICU setting.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PMD64
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Respiratory-Related Disorders, Sensory System Disorders