Economic Analysis of Pulmonary Artery Catheter Use

肺动脉导管使用的经济分析

• 批准号: 6528303
• 负责人: Derek C Angus
• 金额: $ 39.38万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-30 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6528303
• 关键词: adult respiratory distress syndrome; catheterization; cost effectiveness; health economics; human subject; human therapy evaluation; long term survivor; lung injury; patient oriented research; pulmonary artery; quality of life; respiratory disease /disorder therapy; veins

The pulmonary artery catheter (PAC) is a commonly used device that provides hemodynamic data to guide care of the critically ill, such as patients with acute lung injury or the acute respiratory distress syndrome (ARDS/ALI). Clinicians believe PAC use improves decision-making and patient outcomes but evidence is lacking and recent data suggest the PAC may increase mortality as well as considerably increasing costs. In response, the NHLBI funded a large multicenter trial (Fluid And Catheter Treatment Trial (FACTT) (N01-HR-46054-46064)) where ARDS/ALI patients will be randomized to receive a PAC or the less invasive central venous catheter (CVC) and to receive a liberal or conservative fluid management protocol in response to data provided by the PAC or CVC. The primary end-point will be in- patient mortality. We propose to complement FACTT with a concurrent economic analysis of the PAC. Our aims are to: 1.) compare differences between study arms in long-term survival, quality of life, and quality-adjusted survival; 2.) compare differences between study arms in acute care and long-term costs; 3.) calculate the cost- efficacy of PAC use (i.e., the balance of costs and effects under the controlled environment of the FACTT trial), and; 4.) estimate cost-effectiveness under more "real-world" conditions and produce life-time cost-effectiveness ratios, thereby facilitating comparison of our results to other cost-effectiveness analyses. We will achieve Aims 1-3 by augmenting FACTT data collection with detailed information on hospital costs, extended survival follow- up for a minimum of one year, and post-discharge patient interviews to determine quality of life and resource use in the first year. We will achieve Aim 4 by constructing a microsimulation model first calibrated by results from FACTT and published data on life-expectancy and costs and then adjusted to reflect the broader patient case-mix and clinical effects of PAC use in routine clinical practice. We will use patient-level data from the King County Lung Injury Project epidemiology study (NHLBI HL-96-014) to adjust case-mix and patient-level data from a large pragmatic trial of PAC use in the United Kingdom to adjust the clinical effects of PAC use. The results of our proposed adjunct to FACTT will substantially amplify the value of the data being collected and provide, for the first time, robust estimates from randomized data of the economic effects of the widespread application of this important technology.

肺动脉导管（PAC）是一种常用器械，可提供血流动力学数据，以指导重症患者的护理，例如急性肺损伤或急性呼吸窘迫综合征（ARDS/ALI）患者。 临床医生认为PAC的使用改善了决策和患者的结局，但缺乏证据，最近的数据表明PAC可能会增加死亡率，并大大增加成本。 作为回应，NHLBI资助了一项大型多中心试验（液体和导管治疗试验（FACTT）（N 01-HR-46054-46064）），其中ARDS/ALI患者将随机接受PAC或微创中心静脉导管（CVC），并根据PAC或CVC提供的数据接受自由或保守的液体管理方案。 主要终点为住院患者死亡率。我们建议用PAC的同步经济分析来补充FACTT。 我们的目标是：1）比较研究组之间在长期生存率、生活质量和质量调整生存率方面的差异; 2.）比较研究组之间在急性护理和长期成本方面的差异; 3.）计算PAC使用的成本效益（即，在FACTT试验的受控环境下的成本和效果的平衡），以及; 4.）在更“真实”的条件下估计成本效益，并产生终身成本效益比，从而便于将我们的结果与其他成本效益分析进行比较。我们将通过增加FACTT数据收集来实现目标1-3，包括医院费用的详细信息、至少一年的延长生存期随访以及出院后患者访谈，以确定第一年的生活质量和资源使用情况。 我们将通过构建一个微观模拟模型来实现目标4，该模型首先根据FACTT的结果和已发表的预期寿命和成本数据进行校准，然后进行调整以反映更广泛的患者病例组合和PAC在常规临床实践中的临床效果。 我们将使用来自King County肺损伤项目流行病学研究（NHLBI HL-96-014）的患者水平数据来调整病例组合，并使用来自英国PAC使用的大型实用性试验的患者水平数据来调整PAC使用的临床效果。我们提议的FACTT辅助技术的结果将大幅放大所收集数据的价值，并首次根据随机数据对这一重要技术的广泛应用的经济影响进行可靠的估计。