Christopher J Yarnell, Kali Barrett, Anna Heath, Margaret Herridge, Robert A Fowler, Lillian Sung, David M Naimark, George Tomlinson
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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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152783/pdf/","citationCount":"0","resultStr":"{\"title\":\"What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? 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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.</p><p><strong>Results: </strong>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). 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引用次数: 0
摘要
目标： 对低氧血症呼吸衰竭患者启动有创通气的阈值与常规护理相比，估算未来开展随机对照试验的预期价值：估算未来开展随机对照试验的预期价值，该试验将对低氧血症呼吸衰竭患者启动有创通气的阈值与常规护理进行比较：背景：有能力提供有创通气的重症监护病房：环境：能够提供有创通气且在常规（非大流行）实践中不受资源限制的重症监护病房：我们进行了基于模型的成本效用估算，并进行了个体层面的模拟和信息价值分析，重点关注接受无创吸氧的重症监护成人。在主要方案中，我们将假设阈值 A 与常规护理进行了比较，与常规护理相比，阈值 A 导致有创通气的使用增加，并提高了存活率。在次要情景中，我们将假设阈值 B 与常规护理进行了比较，与常规护理相比，阈值 B 可减少有创通气的使用，并提高存活率。我们假设每个质量调整生命年的支付意愿为 100,000 加拿大元（CADs）：在主要方案中，阈值 A 与常规护理相比具有成本效益，因为住院生存率提高（78.1% 对 75.1%），尽管有创通气使用率更高（62% 对 30%），终生成本更高（86,900 加元对 75,500 加元）。在次要方案中，阈值 B 与常规护理相比具有成本效益，因为两者的存活率相似（74.5% 对 74.6%），有创通气使用率较低（20.2% 对 27.6%），终生成本较低（7.17 万加元对 7.47 万加元）。信息价值分析表明，在两种情况下，对低氧血症呼吸衰竭患者进行有创通气阈值与常规护理比较的 400 人随机试验在 10 年内对加拿大社会的预期价值为 13.5 亿加元或更多：结论：与常规治疗相比，确定可提高存活率或在不降低存活率的情况下减少有创通气的阈值对社会极具价值。
What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis.
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.
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