The following is a summary of “What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis,” published in the June 2024 issue of Critical Care by Yarnell et al.
Researchers conducted a retrospective study evaluating the feasibility and potential benefits of randomized controlled trials comparing invasive ventilation thresholds to usual care in patients with hypoxemic respiratory failure.
They employed a model-based cost-utility analysis to estimate the potential value of information regarding optimal thresholds for initiating invasive ventilation in adults with critical illness receiving non-invasive oxygen. After that, 2 hypothetical thresholds (A and B) were compared to usual care. Threshold A led to increased use of invasive ventilation and improved patient survival compared to usual care. Conversely, threshold B resulted in decreased use of invasive ventilation with similar survival rates to usual care. The analysis assumed a $100,000 CAD per quality-adjusted life year willingness-to-pay threshold.
The result showed that threshold A, despite leading to increased use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD), was found to be cost-effective due to improved hospital survival (78.1% vs. 75.1%). On the other hand, threshold B resulted in similar survival rates (74.5% vs. 74.6%) with less invasive ventilation use (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD), making it cost-effective compared to usual care. Additionally, a value-of-information analysis suggested that conducting a 400-person RCT comparing a threshold for invasive ventilation to usual care in patients with hypoxemic respiratory failure could yield an expected value of 1.35 billion CAD or more for Canadian society over 10 years, regardless of the chosen threshold (A or B).
Investigators concluded that optimizing invasive ventilation timing held the key to saving lives or reducing interventions, offering substantial societal benefit.
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