An economic evaluation of prolonged mechanical ventilation
An economic evaluation of prolonged mechanical ventilation
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DOI：
10.1097/01.ccm.0000275391.35834.10
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发表时间：
2007-08-01
影响因子：
8.8
通讯作者：
Sanders, Gillian D.
中科院分区：
文献类型：
--
作者：
Cox, Christopher E.;Carson, Shannon S.;Sanders, Gillian D.
目的：长期接受机械通气的患者资源利用率高，结局相对较差，尤其是老年人，并且数量正在增加。然而，延长机械通气提供的经济影响尚不确定，这对提供者和警察来说是有帮助的。因此，我们的目的是确定长期机械ventilation.Design和Patients的终身社会价值：采用医疗保健支付者的角度来看，我们开发了一个马尔可夫模型，以确定提供机械通气至少21天的成本效益65岁的重症基础病例患者相比，提供舒适的护理，导致撤回通气。输入数据来自医学文献，医疗保险，和最近的一个大型队列研究的通气patients.Measures和主要结果：我们确定了终身成本和生存，质量调整的预期寿命，和成本效益反映的成本，每质量调整的生命年获得。为基础病例患者提供长期机械通气的成本为每生命年增加55，460美元，与撤回通气相比，每质量调整生命年增加82，411美元。成本效果比对年龄、住院费用和再入院概率的变化最敏感，但对急性期后护理设施费用的敏感性较低。具体而言，当年龄为68岁且预测1年死亡率>50%.Conclusions：延长机械通气治疗的成本效益因年龄和短期和长期不良结局的可能性而有显著差异，延长机械通气治疗的每质量调整生命年增量成本超过10万美元。识别可能有不利结果的患者，降低适当患者的护理强度，减少昂贵的再入院应该是未来提高长期机械通气价值的优先事项。
Objective: Patients who receive prolonged mechanical ventilation have high resource utilization and relatively poor outcomes, especially the elderly, and are increasing in number. The economic implications of prolonged mechanical ventilation provision, however, are uncertain and would be helpful to providers and policyrnakers. Therefore, we aimed to determine the lifetime societal value of prolonged mechanical ventilation.Design and Patients: Adopting the perspective of a healthcare payor, we developed a Markov model to determine the cost effectiveness of providing mechanical ventilation for at least 21 days to a 65-yr-old critically ill base-case patient compared with the provision of comfort care resulting in withdrawal of ventilation. Input data were derived from the medical literature, Medicare, and a recent large cohort study of ventilated patients.Measurements and Main Results: We determined lifetime costs and survival, quality-adjusted life expectancy, and cost effectiveness as reflected by costs per quality-adjusted life-year gained. Providing prolonged mechanical ventilation to the base-case patient cost $55,460 per life-year gained and $82,411 per quality-adjusted life-year gained compared with withdrawal of ventilation. Cost-effectiveness ratios were most sensitive to variation in age, hospital costs, and probability of readmission, although less sensitive to postacute care-facility costs. Specifically, incremental costs per quality-adjusted life-year gained by prolonged mechanical ventilation provision exceeded $100,000 with age :68 and when predicted 1-yr mortality was >50%.Conclusions: The cost effectiveness of prolonged mechanical ventilation provision varies dramatically based on age and likelihood of poor short- and long-term outcomes. Identifying patients likely to have unfavorable outcomes, lowering intensity of care for appropriate patients, and reducing costly readmissions should be future priorities in improving the value of prolonged mechanical ventilation.