Journal article
A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome
BMC medical informatics and decision making, Vol.6(1), pp.15-15
03/15/2006
DOI: 10.1186/1472-6947-6-15
PMCID: PMC1431518
PMID: 16539706
Abstract
Management of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU) is clinically challenging and costly. Neuromuscular blocking agents may facilitate mechanical ventilation and improve oxygenation, but may result in prolonged recovery of neuromuscular function and acute quadriplegic myopathy syndrome (AQMS). The goal of this study was to address a hypothetical question via computer modeling: Would a reduction in intubation time of 6 hours and/or a reduction in the incidence of AQMS from 25% to 21%, provide enough benefit to justify a drug with an additional expenditure of $267 (the difference in acquisition cost between a generic and brand name neuromuscular blocker)? The base case was a 55 year-old man in the ICU with ARDS who receives neuromuscular blockade for 3.5 days. A Markov model was designed with hypothetical patients in 1 of 6 mutually exclusive health states: ICU-intubated, ICU-extubated, hospital ward, long-term care, home, or death, over a period of 6 months. The net monetary benefit was computed. Our computer simulation modeling predicted the mean cost for ARDS patients receiving standard care for 6 months to be $62,238 (5%-95% percentiles $42,259-$83,766), with an overall 6-month mortality of 39%. Assuming a ceiling ratio of $35,000, even if a drug (that cost $267 more) hypothetically reduced AQMS from 25% to 21% and decreased intubation time by 6 hours, the net monetary benefit would only equal $137. ARDS patients receiving a neuromuscular blocker have a high mortality, and unpredictable outcome, which results in large variability in costs per case. If a patient dies, there is no benefit to any drug that reduces ventilation time or AQMS incidence. A prospective, randomized pharmacoeconomic study of neuromuscular blockers in the ICU to asses AQMS or intubation times is impractical because of the highly variable clinical course of patients with ARDS.
Details
- Title: Subtitle
- A Markov computer simulation model of the economics of neuromuscular blockade in patients with acute respiratory distress syndrome
- Creators
- Alex Macario - Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305, USA. amaca@stanford.eduJohn L ChowFranklin Dexter
- Resource Type
- Journal article
- Publication Details
- BMC medical informatics and decision making, Vol.6(1), pp.15-15
- DOI
- 10.1186/1472-6947-6-15
- PMID
- 16539706
- PMCID
- PMC1431518
- NLM abbreviation
- BMC Med Inform Decis Mak
- ISSN
- 1472-6947
- eISSN
- 1472-6947
- Publisher
- England
- Language
- English
- Date published
- 03/15/2006
- Academic Unit
- Health Management and Policy; Anesthesia
- Record Identifier
- 9983805900802771
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