Stroke: mechanical ventilation is not cost-effective for preserving quality-of-life

Clinical bottom line (level 1b)

  1. Two-thirds of patients with an acute stroke requiring mechanical ventilation die. Few are discharged home.
  2. Mechanical ventilation is relatively cost-effective for extending life, but not for preserving quality of life.
Mayer et al: Stroke 2000; 31 : 2346-2353
Expires November 2003

The study

cost-effectiveness study
Setting: acute hospital, USA

prospective study of 510 patients aged > 39 hospitalised with an acute stroke followed for 3-6 months

  • Viewpoint: hospital
  • Benefit assessment: survival, quality of life
  • Resources and costs: In 1996 US dollars: cost of hospitalisation (excluding physician fees) plus estimated costs of posthospital care (rehabilitation and skilled nursing facility expenses). Costs were discounted by 3% annually.
  • Sensitivity analysis: Analysis was tested by altering discount rate, costs, rate of survival, setting for rehabilitation, utility of survival

    The evidence

    intervention cost
    life-year saved $37600
    quality-adjusted life-year saved $174300

    Effect of sensitivity analysis: QALY costs were very sensitive to alterations in cost, survival and utility, but only became cost-effective with high survival, low costs and good quality of life on recovery.

    Comments

    1. 10% of patients in the cohort were mechanically ventilated. 65% died within 30 days. 12% were discharged home.

    Citation

    1. Mayer SA, Copeland D, Bernardini GL, et al: cost and outcome of mechanical ventilation for life-threatening stroke. Stroke 2000; 31 : 2346-2353
    Search Terms:
    Contributor: Chris Ball, November 2001
    Reviewer:

    Clinical Question.
    Patient
    Intervention or Exposure
    Outcome