Cost-effectiveness of out-of-hospital continuous positive airway pressure for acute respiratory failure: decision analytic modelling using data from a feasibility trial
| Autor: | Andy Rosser, Gordon Fuller, Praveen Thokala, Steve Goodacre, Tim Harris, Esther Herbert, Maggie Marsh, Matthew Ward, Mike Bradburn, Cindy Cooper, Kate Ren, Gavin D. Perkins, Samuel Keating, Imogen Gunson, Joshua Miller |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cost effectiveness medicine.medical_treatment Cost-Benefit Analysis lcsh:Special situations and conditions Acute respiratory failure 03 medical and health sciences 0302 clinical medicine Oxygen therapy medicine Emergency medical services Humans 030212 general & internal medicine Continuous positive airway pressure health care economics and organizations Cost–benefit analysis Continuous Positive Airway Pressure business.industry lcsh:RC952-1245 030503 health policy & services lcsh:Medical emergencies. Critical care. Intensive care. First aid lcsh:RC86-88.9 Hospitals respiratory tract diseases Quality-adjusted life year Economic evaluation Cohort Emergency medicine Emergency Medicine Feasibility Studies Cost-effectiveness 0305 other medical science business Respiratory Insufficiency Research Article |
| Zdroj: | BMC Emergency Medicine BMC Emergency Medicine, Vol 21, Iss 1, Pp 1-11 (2021) |
| ISSN: | 1471-227X |
| Popis: | Background Standard prehospital management for Acute respiratory failure (ARF) involves controlled oxygen therapy. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment, however, it is uncertain whether this could improve outcomes and provide value for money. This study aimed to evaluate the cost-effectiveness of prehospital CPAP in ARF. Methods A cost-utility economic evaluation was performed using a probabilistic decision tree model synthesising available evidence. The model consisted of a hypothetical cohort of patients in a representative ambulance service with undifferentiated ARF, receiving standard oxygen therapy or prehospital CPAP. Costs and quality adjusted life years (QALYs) were estimated using methods recommended by NICE. Results In the base case analysis, using CPAP effectiveness estimates form the ACUTE trial, the mean expected costs of standard care and prehospital CPAP were £15,201 and £14,850 respectively and the corresponding mean expected QALYs were 1.190 and 1.128, respectively. The mean ICER estimated as standard oxygen therapy compared to prehospital CPAP was £5685 per QALY which indicated that standard oxygen therapy strategy was likely to be cost-effective at a threshold of £20,000 per QALY (67% probability). The scenario analysis, using effectiveness estimates from an updated meta-analysis, suggested that prehospital CPAP was more effective (mean incremental QALYs of 0.157), but also more expensive (mean incremental costs of £1522), than standard care. The mean ICER, estimated as prehospital CPAP compared to standard care, was £9712 per QALY. At the £20,000 per QALY prehospital CPAP was highly likely to be the most cost-effective strategy (94%). Conclusions Cost-effectiveness of prehospital CPAP depends upon the estimate of effectiveness. When based on a small pragmatic feasibility trial, standard oxygen therapy is cost-effective. When based on meta-analysis of heterogeneous trials, CPAP is cost-effective. Value of information analyses support commissioning of a large pragmatic effectiveness trial, providing feasibility and plausibility conditions are met. |
| Databáze: | OpenAIRE |
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