A Cost-effectiveness Analysis of Early vs Late Tracheostomy

Area of Science:

• Critical Care Medicine
• Health Economics
• Surgical Procedures

Background:

• The optimal timing for tracheostomy in mechanically ventilated patients remains debated.
• Economic implications of early versus late tracheostomy strategies are not well-documented.

Purpose of the Study:

• To assess the cost-effectiveness of an early tracheostomy strategy compared to a late tracheostomy strategy.
• To determine the economic impact on US healthcare third-party payers.

Main Methods:

• Decision tree model with a 90-day time horizon.
• Probabilities derived from meta-analyses of randomized clinical trials.
• Cost data from published literature and the Healthcare Cost and Utilization Project database.

Main Results:

• The late tracheostomy strategy cost $45,943.81 (0.36 effectiveness), while the early strategy cost $31,979.12 (0.19 effectiveness).
• The incremental cost-effectiveness ratio for late vs. early tracheostomy was $82,145.24 per tracheostomy avoided.
• At a $50,000 willingness-to-pay threshold, early tracheostomy was cost-effective with 56% certainty.

Conclusions:

• Early tracheostomy is a more cost-effective intervention up to a willingness-to-pay threshold of $80,000 per tracheostomy avoided.
• Decision-makers prioritizing cost-effectiveness may favor an early tracheostomy strategy.
• This analysis provides crucial economic data for clinical decision-making in critical care.