Bedside versus operating room tracheostomy: A cost-effectiveness and economic evaluation.

Area of Science:

• Critical Care Medicine
• Health Economics
• Surgical Procedures

Background:

• Previous studies compared outcomes and costs of bedside tracheostomy (BT) and operating room tracheostomy (ORT).
• A formal cost-effectiveness analysis comparing BT and ORT was lacking.

Purpose of the Study:

• To conduct a cost-effectiveness analysis of BT versus ORT.
• To evaluate the economic value of different tracheostomy procedures.

Main Methods:

• Markov microsimulation model used for cost-effectiveness analysis.
• Model parameters abstracted from existing literature.
• Deterministic and probabilistic sensitivity analyses performed.

Main Results:

• BT demonstrated greater cost-effectiveness than ORT at a $100,000/quality-adjusted life year willingness to pay threshold.
• Model sensitivity identified postoperative pneumonia rates and treatment costs as key factors.
• BT remained more cost-effective across a wide range of willingness to pay thresholds ($0-$200,000).

Conclusions:

• Bedside tracheostomy (BT) is more cost-effective than operating room tracheostomy (ORT) for critically ill patients with low to average risk of postoperative pneumonia.
• Findings suggest prioritizing BT over ORT, irrespective of percutaneous or open approach.
• This supports a shift in procedural consideration for tracheostomy placement.