Cost Analysis of Non-Invasive Helmet Ventilation Compared with Use of Non-Invasive Face Mask in ARDS
CCCF ePoster library. Chaudhuri D. Nov 2, 2016; 151016
Dipayan Chaudhuri
Dipayan Chaudhuri
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#134

Topic: Quality Assurance & Improvement

Cost Analysis of Non-Invasive Helmet Ventilation Compared with Use of Non-Invasive Face Mask in ARDS


Chaudhuri, Dipayan1; Gagnon, Louis-Philippe2; Robidoux, Raphaelle3; Thavorn, Kednapa3; Kobewka, Dan1; Kyeremanteng, Kwadwo4

1 Department of Medicine, University of Ottawa, Ontario, Canada
2 Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
3 University of Ottawa, Ottawa, Ontario, Canada
Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, Ontario, Canada



Abstract:

Introduction: Intensive care unit (ICU) costs have doubled since 2000, totaling 108 billion $ per year. This corresponds to 0.72% of gross domestic product with costs up to 4300$ per patient per day. Acute respiratory distress syndrome (ARDS) has a prevalence of 10.4% and 28-day mortality of 34.8%. Non-invasive ventilation (NIV) is used in up to 30% of cases. A recent randomized controlled trial by Patel et al. showed lower intubation rates and 90-day mortality when comparing helmet to face mask NIV in ARDS.
 
Objective: This study looks at the ICU & hospital cost savings with helmet compared to face-mask NIV in non-intubated patients with ARDS.
 
Methods: The population in the Patel et al. trial was used for analysis. This study analyzed the Patel and colleagues study, which is a single centered ICU associated with the University of Chicago. Cost and cost difference between helmet and face-mask NIV groups were estimated, based on reported ICU and hospital lengths of stay (LOS) and a cost model by Kahn et al. ICU costs and hospital costs are calculated. Costs are in US$ and are adjusted to 2016 US$. 95% confidence intervals are estimated using bootstrap resampling. Projections of cost savings are calculated by multiplying the average cost saving per patient with the total number of patients treated with NIV for ARDS.
 
Results: ICU costs are decreased by 2527$ and hospital costs by 3103$ per patient with helmet NIV, along with a 43.3% absolute reduction in intubation rates and lower ICU LOS, hospital LOS and 90-day mortality. A sensitivity analysis shows consistent cost reductions even with longer LOS in the helmet group. Projected annual cost savings in a single center are 237 538$ in ICU costs and 291 682$ in hospital costs, assuming 3000 ICU admissions, a 10.4% ARDS prevalence, and 30% use of NIV. At a national level, this represents 449 million $ in savings.
 
Conclusion: Helmet NIV compared to face-mask NIV in non-intubated patients with ARDS reduces ICU and hospital direct-variable costs along with intubation rates, LOS and mortality. A large scale cost-effectiveness analysis looking at direct costs rather than projected costs is needed to validate the findings. These analyses will be key to minimize preventable expenses while upholding standard of care and patient outcomes.
 


References:

1. Patel BK, Wolfe KS, Pohlman AS, Hall JB, Kress JP. Effect of Noninvasive Ventilation Delivered by Helmet vs Face Mask on the Rate of Endotracheal Intubation in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2016;315(22):2435-2441. doi: 10.1001/jama.2016.6338

2. 
Kahn JM, Rubenfeld GD, Rohrbach J, Fuchs BD. Cost savings attributable to reductions in intensive care unit length of stay for mechanically ventilated patients. Med Care. 2008;46:1226-33. doi: 10.1097/MLR.0b013e31817d9342



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