title: The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.
abstract: 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.
  
  
  CONCLUSIONS
  PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.
  
  
  BACKGROUND
  www.clinicaltrials.gov NCT00234767.
authors.affiliation: Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. clermontg@upmc.edu
authors.forename: Gilles
authors.initials: G
authors.lastname: Clermont
authors.forename: Lan
authors.initials: L
authors.lastname: Kong
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Weissfeld
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Connors
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Arthur P
authors.initials: AP
authors.lastname: Wheeler
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D055371:Acute Lung Injury / Q000191:economics* / Q000628:therapy*; D002405:Catheterization, Central Venous / Q000191:economics; D002407:Catheterization, Swan-Ganz / Q000191:economics* / Q000379:methods*; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D010351:Patient Discharge / Q000191:economics; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome