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Health economic modeling of the potential cost saving effects of Neurally Adjusted Ventilator Assist
- Source :
- Therapeutic Advances in Respiratory Disease, Vol 10 (2016)
- Publication Year :
- 2015
- Publisher :
- SAGE Publications, 2015.
-
Abstract
- Objectives: Asynchrony between patient and ventilator breaths is associated with increased duration of mechanical ventilation (MV). Neurally Adjusted Ventilatory Assist (NAVA) controls MV through an esophageal reading of diaphragm electrical activity via a nasogastric tube mounted with electrode rings. NAVA has been shown to decrease asynchrony in comparison to pressure support ventilation (PSV). The objective of this study was to conduct a health economic evaluation of NAVA compared with PSV. Methods: We developed a model based on an indirect link between improved synchrony with NAVA versus PSV and fewer days spent on MV in synchronous patients. Unit costs for MV were obtained from the Swedish intensive care unit register, and used in the model along with NAVA-specific costs. The importance of each parameter (proportion of asynchronous patients, costs, and average MV duration) for the overall results was evaluated through sensitivity analyses. Results: Base case results showed that 21% of patients ventilated with NAVA were asynchronous versus 52% of patients receiving PSV. This equals an absolute difference of 31% and an average of 1.7 days less on MV and a total cost saving of US$7886 (including NAVA catheter costs). A breakeven analysis suggested that NAVA was cost effective compared with PSV given an absolute difference in the proportion of asynchronous patients greater than 2.5% (49.5% versus 52% asynchronous patients with NAVA and PSV, respectively). The base case results were stable to changes in parameters, such as difference in asynchrony, duration of ventilation and daily intensive care unit costs. Conclusion: This study showed economically favorable results for NAVA versus PSV. Our results show that only a minor decrease in the proportion of asynchronous patients with NAVA is needed for investments to pay off and generate savings. Future studies need to confirm this result by directly relating improved synchrony to the number of days on MV.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
medicine.medical_treatment
Cost-Benefit Analysis
Diaphragm
Pressure support ventilation
03 medical and health sciences
0302 clinical medicine
Cost Savings
Intensive care
medicine
Neurally adjusted ventilatory assist
Humans
Pharmacology (medical)
Intensive care medicine
Interactive Ventilatory Support
Original Research
lcsh:RC705-779
Mechanical ventilation
Sweden
business.industry
030208 emergency & critical care medicine
lcsh:Diseases of the respiratory system
Respiration, Artificial
Cost savings
Intensive Care Units
Models, Economic
030228 respiratory system
Emergency medicine
business
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Therapeutic Advances in Respiratory Disease, Vol 10 (2016)
- Accession number :
- edsair.doi.dedup.....64f3c2a1a9b51802ffb3bd931fddc6a0