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The effect of pulmonary artery catheter use on costs and Long-Term outcomes of acute lung injury

Clermont, G and Kong, L and Weissfeld, LA and Lave, JR and Rubenfeld, GD and Roberts, MS and Connors, AF and Bernard, GR and Thompson, BT and Wheeler, AP and Angus, DC (2011) The effect of pulmonary artery catheter use on costs and Long-Term outcomes of acute lung injury. PLoS ONE, 6 (7).

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Abstract

Background: The pulmonary artery catheter (PAC) remains widely used in acute lung injury (ALI) despite known complications and little evidence of improved short-term mortality. Concurrent with NHLBI ARDS Clinical Trials Network Fluid and Catheters Treatment Trial (FACTT), we conducted a prospectively-defined comparison of healthcare costs and long-term outcomes for care with a PAC vs. central venous catheter (CVC). We explored if use of the PAC in ALI is justified by a beneficial cost-effectiveness profile. Methods: We obtained detailed bills for the initial hospitalization. We interviewed survivors using the Health Utilities Index Mark 2 questionnaire at 2, 6, 9 and 12 m to determine quality of life (QOL) and post-discharge resource use. Outcomes beyond 12 m were estimated from federal databases. Incremental costs and outcomes were generated using MonteCarlo simulation. Results: Of 1001 subjects enrolled in FACTT, 774 (86%) were eligible for long-term follow-up and 655 (85%) consented. Hospital costs were similar for the PAC and CVC groups ($96.8k vs. $89.2k, p = 0.38). Post-discharge to 12 m costs were higher for PAC subjects ($61.1k vs. 45.4k, p = 0.03). One-year mortality and QOL among survivors were similar in PAC and CVC groups (mortality: 35.6% vs. 31.9%, p = 0.33; QOL [scale: 0-1]: 0.61 vs. 0.66, p = 0.49). MonteCarlo simulation showed PAC use had a 75.2% probability of being more expensive and less effective (mean cost increase of $14.4k and mean loss of 0.3 quality-adjusted life years (QALYs)) and a 94.2% probability of being higher than the $100k/QALY willingness-to-pay threshold. Conclusion: PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI. Trial Registration: www.clinicaltrials.gov NCT00234767. © 2011 Clermont et al.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Clermont, Gcler@pitt.eduCLER
Kong, L
Weissfeld, LA
Lave, JRlave@pitt.eduLAVE
Rubenfeld, GD
Roberts, MSmroberts@pitt.eduMROBERTS
Connors, AF
Bernard, GR
Thompson, BT
Wheeler, AP
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorMalaga, GermanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 27 July 2011
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 6
Number: 7
DOI or Unique Handle: 10.1371/journal.pone.0022512
Schools and Programs: Graduate School of Public Health > Biostatistics
School of Medicine > Critical Care Medicine
Refereed: Yes
MeSH Headings: Acute Lung Injury--economics; Acute Lung Injury--therapy; Catheterization, Central Venous--economics; Catheterization, Swan-Ganz--economics; Catheterization, Swan-Ganz--methods; Cohort Studies; Computer Simulation; Cost-Benefit Analysis; Female; Health Care Costs; Humans; Male; Middle Aged; Monte Carlo Method; Patient Discharge--economics; Sensitivity and Specificity; Time Factors; Treatment Outcome
Other ID: NLM PMC3141060
PubMed Central ID: PMC3141060
PubMed ID: 21811626
Date Deposited: 05 Sep 2012 17:57
Last Modified: 07 Dec 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/13878

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