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Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 12/2022

26.10.2022 | Reports of Original Investigations

Health economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): a cost-effectiveness analysis

verfasst von: MD, MSc Vincent I. Lau, PhD Feng Xie, MDCM, MSc Robert A. Fowler, MD, MSc Bram Rochwerg, MD, PhD Jennie Johnstone, MD, MSc François Lauzier, MD John C. Marshall, MD John Basmaji, MD William Henderson, MD, MBA, MSc Kosar Khwaja, MD, MSc Osama Loubani, MD, MSc, PhD Daniel J. Niven, MD, MSc Ryan Zarychanski, MD Yaseen M. Arabi, MD Rodrigo Cartin-Ceba, PhD Lehana Thabane, MSc Diane Heels-Ansdell, MD, MSc Deborah J. Cook

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2022

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Abstract

Purpose

We sought to compare the cost-effectiveness of probiotics and usual care with usual care without probiotics in mechanically ventilated, intensive care unit patients alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT).

Methods

We conducted a health economic evaluation alongside the PROSPECT randomized control trial (October 2013–March 2019). We adopted a public healthcare payer’s perspective. Forty-four intensive care units in three countries (Canada/USA/Saudi Arabia) with adult critically ill, mechanically ventilated patients (N = 2,650) were included. Interventions were probiotics (Lactobacillus rhamnosus GG) vs placebo administered enterally twice daily. We collected healthcare resource use and estimated unit costs in 2019 United States dollars (USD) over a time horizon from randomization to hospital discharge/death. We calculated incremental cost-effectiveness ratios (ICERs) comparing probiotics vs usual care. The primary outcome was incremental cost per ventilator-associated pneumonia (VAP) event averted; secondary outcomes were costs per Clostridioides difficile-associated diarrhea (CDAD), antibiotic-associated diarrhea (AAD), and mortality averted. Uncertainty was investigated using nonparametric bootstrapping and sensitivity analyses.

Results

Mean (standard deviation [SD]) cost per patient was USD 66,914 (91,098) for patients randomized to probiotics, with a median [interquartile range (IQR)] of USD 42,947 [22,239 to 76,205]. By comparison, for those not receiving probiotics, mean (SD) cost per patient was USD 62,701 (78,676) (median [IQR], USD 41,102 [23,170 to 75,140]; incremental cost, USD 4,213; 95% confidence interval [CI], −2,269 to 10,708). Incremental cost-effectiveness ratios for VAP or AAD events averted, probiotics were dominated by usual care (more expensive, with similar effectiveness). The ICERs were USD 1,473,400 per CDAD event averted (95% CI, undefined) and USD 396,764 per death averted (95% CI, undefined). Cost-effectiveness acceptability curves reveal that probiotics were not cost-effective across wide ranges of plausible willingness-to-pay thresholds. Sensitivity analyses did not change the conclusions.

Conclusions

Probiotics for VAP prevention among critically ill patients were not cost-effective.
Study registration data www.​ClinicalTrials.​gov (NCT01782755); registered 4 February 2013.
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Metadaten
Titel
Health economic evaluation alongside the Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial (E-PROSPECT): a cost-effectiveness analysis
verfasst von
MD, MSc Vincent I. Lau
PhD Feng Xie
MDCM, MSc Robert A. Fowler
MD, MSc Bram Rochwerg
MD, PhD Jennie Johnstone
MD, MSc François Lauzier
MD John C. Marshall
MD John Basmaji
MD William Henderson
MD, MBA, MSc Kosar Khwaja
MD, MSc Osama Loubani
MD, MSc, PhD Daniel J. Niven
MD, MSc Ryan Zarychanski
MD Yaseen M. Arabi
MD Rodrigo Cartin-Ceba
PhD Lehana Thabane
MSc Diane Heels-Ansdell
MD, MSc Deborah J. Cook
Publikationsdatum
26.10.2022
Verlag
Springer International Publishing
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-022-02335-9

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