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Critical Care and Emergency Medicine - Non-Clinical Medicine - Respiratory Medicine - Surgery


The Effect of Pulmonary Artery Catheter Use on Costs and Long-Term Outcomes of Acute Lung Injury
Published: Thursday, July 21, 2011
Author: Gilles Clermont et al.

by 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, for the NHLBI ARDS Clinical Trials Network

Background

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.

Methods

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.

Results

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.

Conclusion

PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.

Trial Registration

www.clinicaltrials.gov NCT00234767

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