Low Tidal Volume in ALI Patients Saves Lives and Ultimately, Money

Implementing low-tidal volume ventilation in patients with acute lung injury (ALI) is cost-effective, researchers reported in the July Chest. “Based on current societal cost-effectiveness standards, we determined that the average ICU should be willing to spend up to $9,500 per patient with ALI to ensure that the patient receives lung-protective ventilation (LPV),” observed Colin R. Cooke, MD, Division of Pulmonary and Critical Care Medicine at the Harborview Medical Center in Seattle, and colleagues.

“Many of the barriers to LPV adherence could theoretically be overcome by implementing a multidisciplinary approach, including protocolized screening and care, bedside decision support, education of existing staff, and audit and feedback,” they explained. “Yet, these approaches carry costs that must be weighed against the clinical benefits of LPV.”

LIFETIME COST OF CARE AND QUALITY OF LIFE

Using a theoretical decision model, investigators compared the cost-effectiveness of low-tidal volume ventilation with and without LPV intervention using data from population-based cohorts of patients with ALI. Cost-effectiveness was characterized as the cost per life saved and the cost per quality-adjusted life-year gained. Parameters used to assess the probability of clinical events in the model were hospital volume of ALI patients per year, ALI risk factors (ie, sepsis, trauma, other), LPV protocol implementation, mortality, and utility (ALI survival or death).

Patients in the LPV group had an average of 4.83 quality-adjusted life-years after hospital discharge, compared with 4.21 in patients in the non-LPV group, results showed. In addition, lifetime cost of care was $106,821 in patients who received LPV, compared with $99,588 in patients that did not. The hospital mortality rate was 31% for patients in the LPV group, compared with 40% for patients in the non-LPV group. In particular, the discounted, age-adjusted average life expectancy for a hospital survivor was 6.5 years in sepsis patients, 13.4 years in trauma patients, and 7.0 years in patients with a condition other than sepsis or trauma.

After combining short- and long-term costs and utilities, the investigators found that the incremental cost-effectiveness ratio was $11,690 per quality-adjusted life-year. “This number reflects the cost of each quality-adjusted life-year gained by delivering LPV to a patient with ALI,” the researchers explained. After costs and lives saved at hospital discharge were combined, the incremental cost-effectiveness for LPV was $22,566 per life saved. “The maximum cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50% to 90% was $9,482,” the study authors found.

IMPLEMENTING LPV

Total number of ventilated days for patients with sepsis and life expectancy of survivors with ALI due to sepsis were the two most influential parameters on the incremental cost-effectiveness ratio for the analysis. However, the study authors noted that LPV remained cost-effective compared with non-LPV over all ranges for each variable in the analysis.

“Through implementing LPV, ICUs and critical care providers have the ability to decrease mortality and, as a result, increase the quality-adjusted life-years for their patients with ALI,” the investigators concluded. “Importantly, our model indicates that LPV can be provided at a lower cost than other commonly used ICU interventions.”

—Frederique H. Theuvenin

Suggested Reading
Cooke RC, Kahn JM, Watkins TR, et al. Cost-effectiveness of implementing low-tidal volume ventilation in patients with acute lung injury. Chest. 2009; 136(1):79-88.

Return to table of contents