SERFAN Innovation, Namur, Belgium; Department of Public Health, Epidemiology & Health Economics, University of Liège, Liège, Belgium.
Baxter World Trade SPRL, Braine l'Alleud, Belgium.
J Crit Care. 2021 Jun;63:45-53. doi: 10.1016/j.jcrc.2021.01.014. Epub 2021 Feb 2.
Mechanical ventilation (MV) is the cornerstone in the management of the acute respiratory distress syndrome (ARDS). Recent research suggests that decreasing the intensity of MV using lung protective ventilation (LPV) with lower tidal volume (Vt) and driving pressure (∆P) could improve survival. Extra-corporal CO removal (ECCOR) precisely enables LPV by allowing lower Vt, ∆P and mechanical power while maintaining PaCO within a physiologic range. This study evaluates the potential cost-effectiveness of ECCOR-enabled LPV in France.
We modelled the distribution over time of ventilated ARDS patients across 3 health-states (alive & ventilated, alive & weaned from ventilation, dead). We compared the outcomes of 3 strategies: MV (no ECCOR), LPV (ECCOR when PaCO > 55 mmHg) and Ultra-LPV (ECCOR for all). Patients characteristics, ventilation settings, survival and lengths of stay were derived from a large ARDS epidemiology study. Survival benefits associated with lower ∆P were taken from the analysis of more than 3000 patients enrolled in 9 randomized trials. Health outcomes were expressed in quality-adjusted life years (QALYs). Incremental cost-effectiveness ratios (ICERs) were computed with both Day 60 cost and Lifetime cost.
Both LPV and ULPV as enabled by ECCO2R provided favorable results at Day 60 as compared to MV. Survival rates were increased with the protective strategies, notably with ULPV that provided even more manifest benefits as compared to MV. LPV and ULPV produced +0.162 and + 0.627 incremental QALYs as compared to MV, respectively. LPV and ULPV costs were augmented because of their survival benefits. Nonetheless, ICERs of LPV and ULPV vs. MV were all well below the €50,000 threshold. ULPV also presented with favorable ICERs as compared to LPV (i.e. less than €25,000/QALY).
ECCOR-enabled LPV strategies might provide cost-effective survival benefit. Additional data from interventional and observational studies are needed to support this preliminary model-based analysis.
机械通气（MV）是急性呼吸窘迫综合征（ARDS）治疗的基石。最近的研究表明，使用肺保护性通气（LPV）降低潮气量（Vt）和驱动压（∆P）可以改善生存率。体外 CO 去除（ECCOR）通过允许更低的 Vt、∆P 和机械功率，同时将 PaCO 维持在生理范围内，从而精确实现 LPV。本研究评估了法国 ECCOR 启用 LPV 的潜在成本效益。
我们模拟了 3 种健康状态（存活并通气、存活并从通气中脱机、死亡）下随时间分布的 ARDS 患者。我们比较了 3 种策略的结果：MV（无 ECCOR）、LPV（PaCO>55mmHg 时使用 ECCOR）和 Ultra-LPV（所有情况下均使用 ECCOR）。患者特征、通气设置、生存和住院时间均来自一项大型 ARDS 流行病学研究。与更低的 ∆P 相关的生存获益来自对 9 项随机试验中超过 3000 名患者的分析。健康结果以质量调整生命年（QALYs）表示。采用第 60 天成本和终生成本计算增量成本效益比（ICER）。
与 MV 相比，LPV 和 ECCOR 启用的 ULPV 在第 60 天均提供了有利的结果。保护策略提高了生存率，尤其是 ULPV 与 MV 相比提供了更明显的获益。LPV 和 ULPV 与 MV 相比分别增加了 0.162 和 0.627 个增量 QALYs。由于生存获益，LPV 和 ULPV 的成本增加。然而，LPV 和 ULPV 与 MV 的 ICER 均远低于 50000 欧元的阈值。与 LPV 相比，ULPV 的 ICER 也更有利（即低于 25000 欧元/QALY）。
ECCOR 启用的 LPV 策略可能提供具有成本效益的生存获益。需要来自干预性和观察性研究的额外数据来支持这一初步的基于模型的分析。
