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
<p><strong>Background</strong></p> <p>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 difficu...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Springer
2020
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| _version_ | 1826270816729300992 |
|---|---|
| author | Khan, I Maredza, M Dritsaki, M Mistry, D Lall, R Lamb, SE Couper, K Gates, S Perkins, GD Petrou, S |
| author_facet | Khan, I Maredza, M Dritsaki, M Mistry, D Lall, R Lamb, SE Couper, K Gates, S Perkins, GD Petrou, S |
| author_sort | Khan, I |
| collection | OXFORD |
| description | <p><strong>Background</strong></p>
<p>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.</p>
<p><strong>Objectives</strong></p>
<p>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.</p>
<p><strong>Methods</strong></p>
<p>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.</p>
<p><strong>Results</strong></p>
<p>NIV was associated with a mean INMB of £620 (US dollars 885) (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 (US dollars 6594 per QALY gained).</p>
<p><strong>Conclusions</strong></p>
<p>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.</p> |
| first_indexed | 2024-03-06T21:46:47Z |
| format | Journal article |
| id | oxford-uuid:49dbb316-3d46-4d70-851e-34a8c9318264 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T21:46:47Z |
| publishDate | 2020 |
| publisher | Springer |
| record_format | dspace |
| spelling | oxford-uuid:49dbb316-3d46-4d70-851e-34a8c93182642022-03-26T15:34:23ZIs protocolised weaning that includes early extubation onto non-invasive ventilation more cost effective than protocolised weaning without non-invasive ventilation? Findings from the Breathe studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:49dbb316-3d46-4d70-851e-34a8c9318264EnglishSymplectic ElementsSpringer2020Khan, IMaredza, MDritsaki, MMistry, DLall, RLamb, SECouper, KGates, SPerkins, GDPetrou, S<p><strong>Background</strong></p> <p>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.</p> <p><strong>Objectives</strong></p> <p>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.</p> <p><strong>Methods</strong></p> <p>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.</p> <p><strong>Results</strong></p> <p>NIV was associated with a mean INMB of £620 (US dollars 885) (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 (US dollars 6594 per QALY gained).</p> <p><strong>Conclusions</strong></p> <p>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.</p> |
| spellingShingle | Khan, I Maredza, M Dritsaki, M Mistry, D Lall, R Lamb, SE Couper, K Gates, S Perkins, GD Petrou, S 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
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