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Is Protocolised Weaning that Includes Early Extubation Onto Non-Invasive Ventilation More Cost Effective Than Protocolised Weaning Without Non-Invasive Ventilation? Findings from the Breathe Study

Author

Listed:
  • Iftekhar Khan

    (University of Warwick
    University of Oxford)

  • Mandy Maredza

    (University of Warwick)

  • Melina Dritsaki

    (University of Oxford)

  • Dipesh Mistry

    (University of Warwick)

  • Ranjit Lall

    (University of Warwick)

  • Sarah E. Lamb

    (University of Warwick
    University of Oxford)

  • Keith Couper

    (University of Warwick)

  • Simon Gates

    (University of Warwick)

  • Gavin D. Perkins

    (University of Warwick)

  • Stavros Petrou

    (University of Warwick
    University of Oxford, Radcliffe Observatory Quarter)

Abstract

Background Optimising techniques to wean patients from invasive mechanical ventilation (IMV) remains a key goal of intensive care practice. The use of non-invasive ventilation (NIV) as a weaning strategy (transitioning patients who are difficult to wean to early NIV) may reduce mortality, ventilator-associated pneumonia and intensive care unit (ICU) length of stay. Objectives Our objectives were to determine the cost effectiveness of protocolised weaning, including early extubation onto NIV, compared with weaning without NIV in a UK National Health Service setting. Methods We conducted an economic evaluation alongside a multicentre randomised controlled trial. Patients were randomised to either protocol-directed weaning from mechanical ventilation or ongoing IMV with daily spontaneous breathing trials. The primary efficacy outcome was time to liberation from ventilation. Bivariate regression of costs and quality-adjusted life-years (QALYs) provided estimates of the incremental cost per QALY and incremental net monetary benefit (INMB) overall and for subgroups [presence/absence of chronic obstructive pulmonary disease (COPD) and operative status]. Long-term cost effectiveness was determined through extrapolation of survival curves using flexible parametric modelling. Results NIV was associated with a mean INMB of £620 ($US885) (cost-effectiveness threshold of £20,000 per QALY) with a corresponding probability of 58% that NIV is cost effective. The probability that NIV is cost effective was higher for those with COPD (84%). NIV was cost effective over 5 years, with an estimated incremental cost-effectiveness ratio of £4618 ($US6594 per QALY gained). Conclusions The probability of NIV being cost effective relative to weaning without NIV ranged between 57 and 59% overall and between 82 and 87% for the COPD subgroup.

Suggested Citation

  • Iftekhar Khan & Mandy Maredza & Melina Dritsaki & Dipesh Mistry & Ranjit Lall & Sarah E. Lamb & Keith Couper & Simon Gates & Gavin D. Perkins & Stavros Petrou, 2020. "Is Protocolised Weaning that Includes Early Extubation Onto Non-Invasive Ventilation More Cost Effective Than Protocolised Weaning Without Non-Invasive Ventilation? Findings from the Breathe Study," PharmacoEconomics - Open, Springer, vol. 4(4), pages 697-710, December.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:4:d:10.1007_s41669-020-00210-1
    DOI: 10.1007/s41669-020-00210-1
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    References listed on IDEAS

    as
    1. Melina Dritsaki & Felix Achana & James Mason & Stavros Petrou, 2017. "Methodological Issues Surrounding the Use of Baseline Health-Related Quality of Life Data to Inform Trial-Based Economic Evaluations of Interventions Within Emergency and Critical Care Settings: A Sys," PharmacoEconomics, Springer, vol. 35(5), pages 501-515, May.
    2. Karl Claxton & Steve Martin & Marta Soares & Nigel Rice & Eldon Spackman & Sebastian Hinde & Nancy Devlin & Peter C Smith & Mark Sculpher, 2013. "Methods for the estimation of the NICE cost effectiveness threshold," Working Papers 081cherp, Centre for Health Economics, University of York.
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    1. Chris Sampson’s journal round-up for 21st December 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-12-21 12:00:05

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