What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis

Christopher J. Yarnell, MD; Kali Barrett, MD, MSc; Anna Heath, PhD; Margaret Herridge, MD, MSc; Robert A. Fowler, MD, MSc; Lillian Sung, MD, PhD; David M. Naimark, MSc, MD; George Tomlinson, PhD

doi:10.1097/CCE.0000000000001098

Critical Care Explorations (Jun 2024)

What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis

Christopher J. Yarnell, MD,
Kali Barrett, MD, MSc,
Anna Heath, PhD,
Margaret Herridge, MD, MSc,
Robert A. Fowler, MD, MSc,
Lillian Sung, MD, PhD,
David M. Naimark, MSc, MD,
George Tomlinson, PhD

Affiliations

Christopher J. Yarnell, MD: 1 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Kali Barrett, MD, MSc: 1 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Anna Heath, PhD: 6 Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
Margaret Herridge, MD, MSc: 1 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Robert A. Fowler, MD, MSc: 1 Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Lillian Sung, MD, PhD: 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
David M. Naimark, MSc, MD: 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
George Tomlinson, PhD: 4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

DOI: https://doi.org/10.1097/CCE.0000000000001098
Journal volume & issue: Vol. 6, no. 6
p. e1098

Abstract

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OBJECTIVES:. To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure. PERSPECTIVE:. Publicly funded healthcare payer. SETTING:. Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice. METHODS:. We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year. RESULTS:. In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios. CONCLUSIONS:. It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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