The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.
<h4>Background</h4>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 condu...
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Public Library of Science (PLoS)
2011-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0022512&type=printable |
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| author | Gilles Clermont Lan Kong Lisa A Weissfeld Judith R Lave Gordon D Rubenfeld Mark S Roberts Alfred F Connors Gordon R Bernard B Taylor Thompson Arthur P Wheeler Derek C Angus NHLBI ARDS Clinical Trials Network |
| author_facet | Gilles Clermont Lan Kong Lisa A Weissfeld Judith R Lave Gordon D Rubenfeld Mark S Roberts Alfred F Connors Gordon R Bernard B Taylor Thompson Arthur P Wheeler Derek C Angus NHLBI ARDS Clinical Trials Network |
| author_sort | Gilles Clermont |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.<h4>Trial registration</h4>www.clinicaltrials.gov NCT00234767. |
| format | Article |
| id | doaj-art-1594efb8596340afae5f165cb8d8f5af |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-1594efb8596340afae5f165cb8d8f5af2025-08-20T03:26:38ZengPublic Library of Science (PLoS)PLoS ONE1932-62032011-01-0167e2251210.1371/journal.pone.0022512The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.Gilles ClermontLan KongLisa A WeissfeldJudith R LaveGordon D RubenfeldMark S RobertsAlfred F ConnorsGordon R BernardB Taylor ThompsonArthur P WheelerDerek C AngusNHLBI ARDS Clinical Trials Network<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.<h4>Trial registration</h4>www.clinicaltrials.gov NCT00234767.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0022512&type=printable |
| spellingShingle | Gilles Clermont Lan Kong Lisa A Weissfeld Judith R Lave Gordon D Rubenfeld Mark S Roberts Alfred F Connors Gordon R Bernard B Taylor Thompson Arthur P Wheeler Derek C Angus NHLBI ARDS Clinical Trials Network The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. PLoS ONE |
| title | The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. |
| title_full | The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. |
| title_fullStr | The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. |
| title_full_unstemmed | The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. |
| title_short | The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. |
| title_sort | effect of pulmonary artery catheter use on costs and long term outcomes of acute lung injury |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0022512&type=printable |
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