An economic evaluation of prolonged mechanical ventilation

Area of Science:

• Critical Care Medicine
• Health Economics
• Geriatric Medicine

Background:

• Prolonged mechanical ventilation (PMV) is associated with high resource utilization and poor outcomes, particularly in elderly patients.
• The economic implications of PMV are not well understood, impacting healthcare providers and policymakers.
• The number of patients requiring PMV is increasing.

Purpose of the Study:

• To determine the lifetime societal value of prolonged mechanical ventilation.
• To evaluate the cost-effectiveness of PMV compared to comfort care.

Main Methods:

• A Markov model was developed from a healthcare payor perspective.
• The model compared mechanical ventilation for at least 21 days versus comfort care withdrawal in a 65-year-old critically ill patient.
• Input data were sourced from medical literature, Medicare, and a large cohort study.

Main Results:

• PMV cost $55,460 per life-year gained and $82,411 per quality-adjusted life-year (QALY) gained compared to comfort care.
• Cost-effectiveness was most sensitive to patient age, hospital costs, and readmission probability.
• Costs per QALY exceeded $100,000 for patients aged 68+ or with >50% predicted 1-year mortality.

Conclusions:

• The cost-effectiveness of PMV is highly variable, depending on patient age and prognosis.
• Identifying patients with poor outcomes is crucial for optimizing PMV value.
• Future priorities include tailoring care intensity and reducing readmissions to improve PMV value.