Abstract | OBJECTIVE: DESIGN: Economic evaluation based on theoretical model. SETTING: This analysis base case was modeled for a tertiary care, teaching hospital. PATIENTS OR OTHER PARTICIPANTS: Carefully selected patients with severe exacerbations of COPD. INTERVENTION: MEASUREMENTS AND MAIN RESULTS: As the hypothesis was dominance, the main outcomes modeled and calculated were costs, mortality rate, and rates of intubation between the two interventions. To determine clinical effectiveness, we used a meta-analysis of randomized trials evaluating the impact of NPPV on hospital survival. A decision tree was constructed and probabilities were applied at each chance node using research evidence and a comprehensive regional database. To provide data for this economic evaluation, MEDLINE literature searches were conducted. Bibliographies of relevant articles were reviewed, as were personal files. To estimate the costs of the alternative therapeutic approaches, eight types of hospitalization days were costed using the London Health Sciences Center costing data. Sensitivity analyses were performed, varying all assumptions made. The meta-analysis yielded an odds ratio for hospital mortality in the NPPV arm, compared with standard therapy, of 0.22 (95% confidence interval, 0.10-0.66). By using baseline case assumptions, we found a cost savings of $3,244 (1996, Canadian), per patient admission, if NPPV were adopted in favor of standard therapy. These findings present a scenario of clear dominance for treatment with NPPV. Sensitivity analyses did not alter the results appreciably. CONCLUSIONS: We conclude that from a hospital's perspective, NPPV and standard therapy for carefully selected patients with acute, severe exacerbations of COPD are more effective and less expensive than standard therapy alone.
|
Authors | S P Keenan, J Gregor, W J Sibbald, D Cook, A Gafni |
Journal | Critical care medicine
(Crit Care Med)
Vol. 28
Issue 6
Pg. 2094-102
(Jun 2000)
ISSN: 0090-3493 [Print] United States |
PMID | 10890671
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
|
Topics |
- Acute Disease
- Cost-Benefit Analysis
- Decision Trees
- Humans
- Lung Diseases, Obstructive
(therapy)
- Models, Theoretical
- Positive-Pressure Respiration
(economics)
- Sensitivity and Specificity
- Severity of Illness Index
- Time Factors
|