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Updated: Jan 7, 2026
Asthma Detection Research Based on Voice Signal Processing and Machine Learning
Published on: July 22, 2025
An Early-Stage Decision-Analytic Health Economic Model of Above Cuff Vocalization: What Do We Know and What Do We
Claire S Mills1,2,3, Emilia Michou4,5, Mark C Bellamy6
1Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Objectives:
Above cuff vocalization (ACV) is used in patients with a tracheostomy in the ICU despite limited evidence. This early-stage decision-analytic model (DAM) for ACV evaluates the expected cost-effectiveness exploring the impact of uncertainty to identify key drivers of cost and effect and critical further research priorities.
Perspective:
U.K. National Health Service.
Setting:
Hypothetical cohort of general ICU patients with a tracheostomy, 63 years old, 64% male.
Methods:
A de novo decision-analytic health economic model comparing ACV to usual care (UC). Model parameters were acquired from the literature review and expert opinion. One-way sensitivity analyses were conducted to identify key drivers of cost-effectiveness.
Results:
The daily cost of ACV in the ICU ranged from £75 to 89 (USD 101-120), with most of this cost attributable to staff resources for delivery. The base-case scenario revealed ACV is potentially cost-effective, dominating UC with cost savings of £9,488 (USD 12,808) and 0.395 Quality-Adjusted Life Years gained. Most sensitivity analyses revealed that ACV dominated UC, costing less and being more effective. When ACV had a negative impact on ICU and ward length of stay (LoS), or had no effect on the speed of weaning, it was not cost-effective. The primary driver of cost was whether ACV affected the speed of weaning and ICU LoS. The two primary drivers of effect were: i) whether ACV impacted which end state a patient transitioned to and ii) whether ACV had a sustained positive impact on quality of life.
Conclusions:
Despite the substantial input required from speech-language pathologists-a typically scarce resource in ICU settings-ACV demonstrates strong potential for cost-effectiveness. There is no reason for decision-makers to de-adopt ACV, and delaying adoption may result in loss of opportunity costs. Improved reporting of mortality and utility data in critical care research would increase the reliability of early-stage DAMs.
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