Acute respiratory distress syndrome cost-effectiveness of therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]

Although ARDS is a serious medical condition associated with a very high mortality rate, the application of evidence-based therapies (e.g., lower tidal volume mechanical ventilation) have been shown to be cost-effective.

Although ICU-level care can be very costly, the use of low tidal volume mechanical ventilation appears to be cost-effective:

• One study of patients with respiratory failure due to pneumonia or ARDS concluded that mechanical ventilation was cost-effective when the probability of surviving at least 2 months following mechanical ventilation was > 50%:^[1]

• When the probability of surviving at least 2 months was > 70%, the cost per quality-adjusted life year (QALY) was $29,000
• When the probability of surviving at least 2 months was 51 to 70%, the cost per QALY was $44,000
• When the probability of surviving at least 2 months was < 50%, the cost per QALY was $110,000

• One study of patients with acute lung injury (ALI) concluded that the implementation of low tidal volume mechanical ventilation (lung protective ventilation) was more cost-effective compared to other, non-lung-protective mechanical ventilation strategies, with an increase in quality-adjusted life years (QALYs) of 15% at an additional cost of $7,233 per patient treated with lung-protective ventilation.^[2]
• The CESAR trial compared conventional mechanical ventilation practices to extracorporeal membrane oxygenation (ECMO) in patients with severe ARDS and calculated a QALY gain of 0.03 at a cost of £19,252 (roughly $31,000 in the year when the study was published).^[3]