The cost-effectiveness of venous-converted acid-base and blood gas status in pulmonary medical departments

Abstract

Lars Oddershede1, Sabrina Storgaard Petersen1, Asgerd Krogh Kristensen2, Jan Freddy Pedersen3, Stephen Edward Rees1, Lars Ehlers41Department of Health Science and Technology, Aalborg University, Aalborg, Denmark; 2Department of Pulmonary Medicine, Aalborg Hospital Section South, Aalborg, Denmark; 3Department of Clinical Biochemistry, Aalborg Hospital Section South, Aalborg, Denmark; 4Health Economics and Management, Aalborg University, Aalborg, DenmarkIntroduction: The current use of arterial punctures, when obtaining arterial blood gas and acid-base status of patients, are associated with a risk of side effects such as pain and hematoma, and a small risk of more severe complications. This analysis investigated the cost-effectiveness of a new method, where less painful venous-converted tests are used as an alternative to arterial punctures.Methods: A cost–utility analysis was conducted from the Danish hospital perspective using a Markov model. The model represents the admission of a typical patient suffering from chronic obstructive pulmonary disease to the Department of Pulmonary Medicine, Aalborg Hospital. Evidence of the effect of the venous-converted tests’ pain reduction was converted into short-term gain in quality-adjusted life years (QALYs), using the Danish EuroQol-5 Dimension value set. A Monte Carlo second order simulation of 10,000 hypothetical patients was conducted for a midsized and a small department.Results: Monte Carlo simulation of the incremental cost-effectiveness ratio (ICER) was dominant for a midsized department, and for a small department the mean was £10,645 per QALY gained. The scatter plot of ICERs revealed that at a willingness-to-pay (WTP) of £30,000 per QALY gained, the venous conversion method is >95% cost-effective in a midsized department and 51% in a small department.Conclusion: It was concluded that the venous conversion method should be applied to hospitals with midsized pulmonary departments, and could be applied to small pulmonary departments if the WTP is sufficient.Keywords: arterial punctures, cost–utility analysis, Markov model, pain, hematoma