Pulmonary artery catheterization in exacerbations of COPD requiring mechanical ventilation: a cost-effectiveness analysis.
The cost-effectiveness of pulmonary artery catheterization (PAC) has been questioned in many clinical situations. We sought to assess the cost-effectiveness of PAC in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.


METHODS
We constructed a decision analysis model and calculated the incremental cost/quality-adjusted life-year (QALY) saved for hypothetical patients, comparing a PAC strategy to one of no PAC. Sensitivity analyses were performed to test the stability of conclusions over wide ranges of values.


RESULTS
The incremental cost/QALY saved in the cost-effectiveness analysis using baseline data is $77,407 when catheterization-driven therapeutic changes result in a 5% improvement in survival. Cost-effectiveness is sensitive to variations in post-hospital life expectancy, quality of life, and the probability of favorable therapeutic changes resulting from the use of catheterization data.


CONCLUSIONS
Pulmonary artery catheterization in COPD exacerbation requiring mechanical ventilation is expensive compared to accepted medical interventions for other conditions, unless changes in therapy prompted by catheterization increase hospital survival to a level 8.7% above baseline. Randomized, controlled trials are needed to investigate the economic impact of PAC and its effect on morbidity and mortality of critically ill patients.
Mercy Hospital of Pittsburgh, PA 15219.
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KJ
Smith
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D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017721:Hospital Costs; D006801:Humans; D008017:Life Expectancy; D008173:Lung Diseases, Obstructive / Q000191:economics / Q000628:therapy*; D010414:Pennsylvania; D011651:Pulmonary Artery / Q000601:surgery*; D011788:Quality of Life; D012121:Respiration, Artificial; D013673:Technology Assessment, Biomedical / Q000191:economics; D026712:Value of Life