Health-Economic Value of Transvenous Diaphragm Neurostimulation in Ventilator Weaning.

Abstract

Prolonged mechanical ventilation presents a substantial clinical and economic burden. Transvenous diaphragm neurostimulation (tDNS) has demonstrated an increased rate of successful weaning and reduced duration of ventilation among mechanically ventilated patients. This exploratory analysis sought to quantify the potential short-term health-economic implications in the acute hospital setting, as well as potential lifetime benefits resulting from improved weaning in mechanically ventilated patients receiving tDNS compared with the standard of care (SoC). A cost-consequence analysis was conducted, reporting short-term economic outcomes for tDNS- vs. SoC-treatment strategies in a U.S. setting, based on recent clinical data from the RESCUE-3 randomized trial and real-world claims data. A lifetime projection model informed long-term survival and quality-of-life implications in an exploratory analysis. The primary outcomes included stakeholder-specific incremental costs and quality-adjusted life-year (QALY) gain with tDNS. Extensive sensitivity analyses and validations were performed. None. Under the base case assumptions, a 2.8-day reduction in mechanical ventilation utilization and 10.5% greater weaning success led to projected cost savings of $12,102 in the acute setting and $11,999 in the long-term care hospital setting, before consideration of tDNS cost. Favorable cost savings materialized across sensitivity analyses employing a range of clinical and cost assumptions. An increase in acute weaning with tDNS may lead to 0.10-0.68 QALYs gained over patients' remaining lifetime. Based on these exploratory findings, improved weaning rates with tDNS will likely lead to meaningful cost savings in acute and long-term care settings, and concurrent long-term QALY gains that, depending on therapy cost, may render tDNS a cost-effective, high-value intervention. Future lifetime cost-effectiveness analyses are warranted.