PURPOSE: To conduct a cost-effectiveness analysis (CEA) of use of continous positive airway pressure (cPAP) in patients screened for postoperative hypoxia after undergoing elective abdominal surgery.
METHODS: A decision tree analytical model was constructed to study the cost-effectiveness of cPAP compared to usual care of delivering 50% FiO2 via venture mask in 65 year old patients who develop hypoxia in the post-extubation phase of elective abdominal surgeries. Third party payer perspective was used and the analysis was conducted over a one year duration. Efficacy data were taken from the study by Squadrone et al(JAMA 2005; 293:589–595). Life years were adjusted using published utilities to derive quality adjusted life years (QALY). Year 2006 Medicare reimbursements were used for cost data. Results were calculated in incremental cost per QALY gained.
RESULTS: Base-case analysis showed total cost of cPAP therapy to be around $578 compared to $2463 for conventional treatment with CPAP providing 0.001 QALYs more than conventional therapy. Hence conventional therapy with oxygen alone is dominated (i.e. has higher costs and fewer QALYs by the cPAP intervention. Univariate and bivariate sensitivity analyses showed that baseline results were insensitive to variation of various efficacy and cost parameters over a wide range. 1000 first order Monte Carlo simulations were conducted and incremental net monetary benefits (INMB) were calculated. These simulations showed that cPAP therapy dominates conventional therapy across wide range of willingness to pay thresholds (WTP) with 95% CI ranging between -$72 to $9,338 (WTP of $50,000/QALY) to -$72 to $9,873 (WTP of $100,000/QALY).
CONCLUSION: Our analyses showed that cPAP therapy is a cost-effective intervention to treat patients with post-surgical hypoxia after elective abdominal surgeries.
CLINICAL IMPLICATIONS: Hypoxemia complicates 30–50% of elective abdominal surgeries in the postoperative period with 8–10% patients requiring mechanical ventilation. Early application of cPAP can be cost effective beside decreasing the risk of postoperative pneumonia; surgical site infection and sepsis.
DISCLOSURE: Sanjeev Suri, No Financial Disclosure Information; No Product/Research Disclosure Information