Evidence map›Paper›PMID 38836575›Full record

ArticleCritical care explorations2024

What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis.

Christopher J Yarnell, Kali Barrett, Anna Heath, Margaret Herridge, Robert A Fowler, Lillian Sung, David M Naimark, George Tomlinson

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care explorations, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Christopher J YarnellInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Kali BarrettInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Anna HeathChild Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
Margaret HerridgeInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Robert A FowlerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Lillian SungInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
David M NaimarkInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
George TomlinsonInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

Funding

CIHR Vanier Scholar
6 · The paper itself

Abstract

objectivesTo estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure. PERSPECTIVE: Publicly funded healthcare payer.

settingCritical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice.

methodsWe performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year.

resultsIn the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios.

conclusionsIt would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.

Indexed as

Cost-Benefit AnalysisRandomized Controlled Trials as TopicRespiration, ArtificialRespiratory InsufficiencyAdultCanadaHumansIntensive Care UnitsQuality-Adjusted Life Years

Identifiers

PMID38836575
PMCPMC11152783

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.