title: Cost-effectiveness of implementing low-tidal volume ventilation in patients with acute lung injury.
abstract: BACKGROUND
  Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective.
  
  
  METHODS
  Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained.
  
  
  RESULTS
  Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were $22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90% was $9,482. Results were robust to a wide range of economic and patient parameter assumptions.
  
  
  CONCLUSIONS
  Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. Electronic address: crcooke@u.washington.edu.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.affiliation: Division of Pulmonary, Allergy & Critical Care, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Watkins
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Leonard D
authors.initials: LD
authors.lastname: Hudson
authors.affiliation: Interdepartmental Division of Critical Care, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld