The Effect of Pulmonary Artery Catheter Use on Costs and Long-Term Outcomes of Acute Lung Injury
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{"title"=>"The effect of pulmonary artery catheter use on costs and Long-Term outcomes of acute lung injury", "type"=>"journal", "authors"=>[{"first_name"=>"Gilles", "last_name"=>"Clermont", "scopus_author_id"=>"7004041664"}, {"first_name"=>"Lan", "last_name"=>"Kong", "scopus_author_id"=>"15068480300"}, {"first_name"=>"Lisa A.", "last_name"=>"Weissfeld", "scopus_author_id"=>"7004114531"}, {"first_name"=>"Judith R.", "last_name"=>"Lave", "scopus_author_id"=>"35431889700"}, {"first_name"=>"Gordon D.", "last_name"=>"Rubenfeld", "scopus_author_id"=>"7007105959"}, {"first_name"=>"Mark S.", "last_name"=>"Roberts", "scopus_author_id"=>"7404029525"}, {"first_name"=>"Alfred F.", "last_name"=>"Connors", "scopus_author_id"=>"7005477550"}, {"first_name"=>"Gordon R.", "last_name"=>"Bernard", "scopus_author_id"=>"7101980942"}, {"first_name"=>"B. Taylor", "last_name"=>"Thompson", "scopus_author_id"=>"55663567700"}, {"first_name"=>"Arthur P.", "last_name"=>"Wheeler", "scopus_author_id"=>"7102758830"}, {"first_name"=>"Derek C.", "last_name"=>"Angus", "scopus_author_id"=>"7102124583"}], "year"=>2011, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-79960619692", "sgr"=>"79960619692", "pui"=>"362190959", "isbn"=>"1932-6203 (Electronic) 1932-6203 (Linking)", "pmid"=>"21811626", "doi"=>"10.1371/journal.pone.0022512"}, "id"=>"a79d65f7-7a81-330d-aa60-df351a3a89e8", "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.\\n\\nMETHODS: 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.\\n\\nRESULTS: 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.\\n\\nCONCLUSION: PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI.\\n\\nTRIAL REGISTRATION: www.clinicaltrials.gov NCT00234767.", "link"=>"http://www.mendeley.com/research/effect-pulmonary-artery-catheter-costs-longterm-outcomes-acute-lung-injury-1", "reader_count"=>34, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>5, "Researcher"=>6, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>3, "Student > Master"=>8, "Other"=>2, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>5}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>5, "Researcher"=>6, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>3, "Student > Master"=>8, "Other"=>2, "Student > Bachelor"=>1, "Lecturer"=>1, "Professor"=>5}, "reader_count_by_subject_area"=>{"Engineering"=>2, "Mathematics"=>1, "Medicine and Dentistry"=>24, "Agricultural and Biological Sciences"=>3, "Arts and Humanities"=>1, "Psychology"=>1, "Social Sciences"=>1, "Linguistics"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>24}, "Social Sciences"=>{"Social Sciences"=>1}, "Psychology"=>{"Psychology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>3}, "Linguistics"=>{"Linguistics"=>1}, "Mathematics"=>{"Mathematics"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}}, "reader_count_by_country"=>{"France"=>1}, "group_count"=>5}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/754351"], "description"=>"<p>Quorum chart of the EA-PAC cohort.</p>", "links"=>[], "tags"=>["ea-pac"], "article_id"=>424704, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.g001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Quorum_chart_of_the_EA_PAC_cohort_/424704", "title"=>"Quorum chart of the EA-PAC cohort.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 16:32:34"}
  • {"files"=>["https://ndownloader.figshare.com/files/755184"], "description"=>"<p>SD - standard deviation; PAC - pulmonary artery catheter; CVC - central venous catheter; NS - non-significant.</p>", "links"=>[], "tags"=>["surgery", "Critical care and emergency medicine", "respiratory medicine", "Non-clinical medicine"], "article_id"=>425552, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t004", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Post_discharge_resource_use_/425552", "title"=>"Post-discharge resource use.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:37:04"}
  • {"files"=>["https://ndownloader.figshare.com/files/754860"], "description"=>"<p>Overall post-discharge costs were significantly higher in patients assigned to the PAC. There was a trend in most categories of costs favoring CVC, but only post-discharge rehabilitation costs were significantly different. Of note, the difference was most apparent at the 9 and 12 month follow-up point (data not shown).</p>", "links"=>[], "tags"=>["surgery", "Critical care and emergency medicine", "respiratory medicine", "Non-clinical medicine"], "article_id"=>425223, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.g004", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Post_discharge_resource_use_/425223", "title"=>"Post-discharge resource use.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 16:35:19"}
  • {"files"=>["https://ndownloader.figshare.com/files/755306"], "description"=>"<p>CMS - Center for Medicare and Medicaid Services.</p>", "links"=>[], "tags"=>["post-discharge"], "article_id"=>425673, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_weight_in_the_assessment_of_post_discharge_resource_use_/425673", "title"=>"Cost weight in the assessment of post-discharge resource use.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:37:46"}
  • {"files"=>["https://ndownloader.figshare.com/files/754711"], "description"=>"<p>Median Health-related quality-of-life, measured by the Health Utilities Index, is uniformly low in the EA-PAC cohort, although the inter-quartile range is wide and individual values spread the entire 0–1 interval. Utilities are lowest at 90 days and improved by 9 months. Subjects assigned to the PAC were no different than those assigned to the CVC.</p>", "links"=>[], "tags"=>["surgery", "Critical care and emergency medicine", "respiratory medicine", "Non-clinical medicine"], "article_id"=>425068, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.g003", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Utility_by_treatment_arm_/425068", "title"=>"Utility by treatment arm.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 16:34:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/755347"], "description"=>"<p>SD - standard deviation; MAP - Mean arterial pressure; CI - Cardiac index; TV - Tidal volume.</p>", "links"=>[], "tags"=>["ea-pac", "factt"], "article_id"=>425712, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t002", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Comparison_of_EA_PAC_and_FACTT_Cohort_/425712", "title"=>"Comparison of EA-PAC and FACTT Cohort.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:37:58"}
  • {"files"=>["https://ndownloader.figshare.com/files/755226"], "description"=>"<p>SD- standard deviation; PAC – Pulmonary artery catheter; CVC – Central venous catheter; QALY – Quality adjusted life-years.</p>*<p>With replacement of outliers exceeding the 95th percentile.</p>", "links"=>[], "tags"=>["costs", "monte", "carlo"], "article_id"=>425586, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t005", "stats"=>{"downloads"=>3, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimates_of_mean_costs_and_effects_from_Monte_Carlo_simulations_/425586", "title"=>"Estimates of mean costs and effects from Monte Carlo simulations.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:37:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/754524"], "description"=>"<p>Trends seen in the FACTT trial persist to one year of follow-up. Although patients with CVC have higher cumulative survival, the difference is not significant (p = 0.33, log-rank).</p>", "links"=>[], "tags"=>["surgery", "Critical care and emergency medicine", "respiratory medicine", "Non-clinical medicine"], "article_id"=>424885, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.g002", "stats"=>{"downloads"=>3, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Survival_by_treatment_arm_/424885", "title"=>"Survival by treatment arm.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 16:33:38"}
  • {"files"=>["https://ndownloader.figshare.com/files/755384"], "description"=>"<p>SD =  standard deviation; PAC  =  pulmonary artery catheter; CVC  =  central venous catheter.</p>", "links"=>[], "tags"=>["characteristics", "ea-pac"], "article_id"=>425750, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t003", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_by_treatment_assignment_for_the_EA_PAC_cohort_/425750", "title"=>"Baseline characteristics by treatment assignment for the EA-PAC cohort.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:38:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/755035"], "description"=>"<p>The mean estimate of incremental costs and effects suggest that the PAC is both more expensive and less effective (panel A). The 95% confidence ellipse only marginally dips below the 50 k/QALY willingness-to-pay threshold with the vast majority of trials agreeing with the mean estimate that the PAC is an inferior strategy. The corresponding cost-effectiveness acceptability curve conveys the probability of the PAC to be cost-effective at various willingness-to-pay thresholds (Panel B, x-axis). Even if willingness-to-pay was unlimited, there is only a 20.8% probability of the PAC to be cost effective (Panel B, dotted line). The PAC displays a better cost-effectiveness profile in subjects treated with a conservative fluid strategy (panel C) than those receiving a liberal strategy. A similar trend is seen in subjects where the study protocol was instituted early after enrolment (panel D). Yet, for both subgroups, there was a high probability for the PAC to be an ineffective strategy.</p>", "links"=>[], "tags"=>["pulmonary", "artery"], "article_id"=>425400, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.g005", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_effectiveness_of_the_Pulmonary_Artery_Catheter_/425400", "title"=>"Cost-effectiveness of the Pulmonary Artery Catheter.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-20 16:36:15"}
  • {"files"=>["https://ndownloader.figshare.com/files/755266"], "description"=>"<p>PAC – Pulmonary artery catheter; QALY – quality-adjusted life-year.</p>", "links"=>[], "tags"=>["estimates", "costs", "ea-pac"], "article_id"=>425631, "categories"=>["Medicine"], "users"=>["Gilles Clermont", "Lan Kong", "Lisa A. Weissfeld", "Judith R. Lave", "Gordon D. Rubenfeld", "Mark S. Roberts", "Alfred F. Connors Jr.", "Gordon R. Bernard", "B. Taylor Thompson", "Arthur P. Wheeler", "Derek C. Angus"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0022512.t006", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Mean_estimates_of_costs_and_effects_for_EA_PAC_subgroups_/425631", "title"=>"Mean estimates of costs and effects for EA-PAC subgroups.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-20 16:37:32"}

PMC Usage Stats | Further Information

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Relative Metric

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