Abstract
Objectives
There is a lack of economic evaluation evidence on the optimal oxygen dosing level for mechanically ventilated critically ill patients. This study reports the health economic outcomes of a large-scale randomized controlled trial (RCT), UK-ROX, and conducts a full cost-effectiveness analysis of conservative versus usual oxygen therapy.Methods
All-cause mortality, health related quality of life (HrQoL), quality-adjusted life-years (QALYs), costs, and incremental net monetary benefit (INB) were assessed at 90 days post-randomization. HrQoL was derived from information collected via an EQ-5D-5L questionnaire using an appropriate mapping function. Total healthcare costs include resource use that occurred in adult ICUs, general wards, and follow-up health services. The cost effectiveness analysis (CEA) used regression methods to report the cost-effectiveness and summarised the uncertainties around the incremental cost-effectiveness results.Results
After adjustment for prespecified baseline variables, the estimated incremental costs of conservative oxygen therapy versus usual oxygen therapy were -£968 (95% CI -£2279 to £342). The adjusted mean differences in EQ-5D utility score and life-years were 0.004 (95% CI -0.016 to 0.025) and -0.003 (95% CI -0.006 to 0.001), and incremental QALYs were 0.001 (95% CI -0.002 to 0.003). As a result, the mean INB of conservative oxygen therapy was £979 (95% CI -£334 to £2292).Conclusions
Conservative and usual oxygen therapy resulted in similar QALYs, and while conservative therapy appeared cost-saving with positive INBs, both estimates have uncertainty.