Source avec lien : Journal of Patient Safety, 17(2), . 10.1097/PTS.0000000000000582
La ventilation mécanique augmente le risque d’affections nosocomiales (HAC) telles que la pneumonie sous ventilation (PAV) et les lésions dues à la pression (LPR). Il est démontré que les lits à rotation latérale continue (CLRT) réduisent l’incidence des MAC, mais l’intérêt de passer aux lits CLRT est actuellement inconnu. Nous avons comparé le rapport coût-efficacité des lits CLRT avec les soins standard dans les unités de soins intensifs.
Objectives Mechanical ventilation increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injury (PrI). Beds with continuous lateral rotation therapy (CLRT) are shown to reduce HAC incidence, but the value of switching to CLRT beds is presently unknown. We compared the cost-effectiveness of CLRT beds with standard care in intensive care units. Methods A cost-effectiveness analysis from the healthcare sector and societal perspectives was conducted. A Markov model was constructed to predict health state transitions from time of ventilation through 28 days for the healthcare sector perspective and 1 year for the U.S. societal perspective. Value of information was calculated to determine whether parameter uncertainty warranted further research. Results Our analysis suggested that CLRT beds dominate standard care from both perspectives. From the healthcare sector perspective, expected cost for CLRT was U.S. $47,165/patient compared with a higher cost of U.S. $49,258/patient for standard care. The expected effectiveness of CLRT is 0.0418 quality-adjusted life years/patient compared with 0.0416 quality-adjusted life years/patient for standard care. Continuous lateral rotation therapy dominated standard care in approximately 93% of Monte Carlo simulations from both perspectives. Value of information analysis suggests that additional research is potentially cost-effective. Conclusions Continuous lateral rotation therapy is highly cost-effective compared with standard care by preventing HACs that seriously harm patients in the intensive care unit.