TY - JOUR
T1 - Health Economic Evaluation of a Strict Glucose Control Guideline Implemented Using Point-of-Care Testing in Three Intensive Care Units in The Netherlands
AU - van Hooijdonk, Roosmarijn T.M.
AU - Steuten, Lotte Maria Gertruda
AU - Kip, Michelle Maria Aleida
AU - Monteban, Helma
AU - Mulder, Marianne R.
AU - van Braam Houckgeest, Floris
AU - van der Sluijs, Johannes P.
AU - Abu-Hanna, Ameen
AU - Spronk, Peter E.
AU - Schultz, Marcus J.
PY - 2015/5/10
Y1 - 2015/5/10
N2 - Background
Point-of-care testing of blood glucose (BG-POCT) is essential for safe and effective insulin titrations in critically ill patients under glucose control with insulin. The costs associated with this practice are considered substantial, especially when more frequent blood glucose (BG) testing is needed, as with more strict glucose control (SGC) aiming for lower BG levels.
Objective
The objective of this study was to estimate, from a hospital perspective, the incremental cost effectiveness of an SGC guideline, aiming for BG levels of 4.4–6.1 mmol/L, compared to the situation before implementation of that guideline (aiming for BG levels <8.3 mmol/L), both using BG–POCT.
Methods
This is a secondary analysis of a guideline implementation project aiming for implementation of a guideline of SGC in three intensive care units in The Netherlands. A Markov model including the four health states ‘target glucose’, ‘hyperglycaemia’ (defined as BG levels >6.1 mmol/L), ‘hypoglycaemia’ (defined as BG levels <4.4 mmol/L) and ‘in-hospital death’ was developed to compare expected costs, number of patients within target and number of life-years saved before and after implementation of the SGC guideline. The effectiveness estimates are based on empirical data from 3195 patients 12 and 24 months before and after implementation of the guideline, respectively. All costs have been converted to price year 2013, and are estimated based on hospital data, the literature and available price lists.
Results
The number of BG–POCT increased from 4.8 [interquartile range (IQR) 2.6–6.7] to 8.0 [IQR 4.1–11.2] per patient per day, accruing 58 % higher costs for BG–POCT (€13.56 vs. €8.57 per patient) in the SGC protocol versus the situation before implementation. When taking total hospital costs and clinical effects into account, implementation of the SGC guideline increased total hospital costs per patient by 1.8 %, i.e. €355 (from €20,617 to €20,972) during the inpatient stay, while the number of patients in target glucose levels increased by 1.4 % (i.e. from 881 to 895 per 1000 patients). This translates to an incremental cost-effectiveness ratio of €25 per additional patient within the target glucose level. The model outcomes are most sensitive to changes in ICU length of stay.
Conclusion
The increase in the number of patients and time within target glucose levels is achieved with a small increase in total direct hospital costs
AB - Background
Point-of-care testing of blood glucose (BG-POCT) is essential for safe and effective insulin titrations in critically ill patients under glucose control with insulin. The costs associated with this practice are considered substantial, especially when more frequent blood glucose (BG) testing is needed, as with more strict glucose control (SGC) aiming for lower BG levels.
Objective
The objective of this study was to estimate, from a hospital perspective, the incremental cost effectiveness of an SGC guideline, aiming for BG levels of 4.4–6.1 mmol/L, compared to the situation before implementation of that guideline (aiming for BG levels <8.3 mmol/L), both using BG–POCT.
Methods
This is a secondary analysis of a guideline implementation project aiming for implementation of a guideline of SGC in three intensive care units in The Netherlands. A Markov model including the four health states ‘target glucose’, ‘hyperglycaemia’ (defined as BG levels >6.1 mmol/L), ‘hypoglycaemia’ (defined as BG levels <4.4 mmol/L) and ‘in-hospital death’ was developed to compare expected costs, number of patients within target and number of life-years saved before and after implementation of the SGC guideline. The effectiveness estimates are based on empirical data from 3195 patients 12 and 24 months before and after implementation of the guideline, respectively. All costs have been converted to price year 2013, and are estimated based on hospital data, the literature and available price lists.
Results
The number of BG–POCT increased from 4.8 [interquartile range (IQR) 2.6–6.7] to 8.0 [IQR 4.1–11.2] per patient per day, accruing 58 % higher costs for BG–POCT (€13.56 vs. €8.57 per patient) in the SGC protocol versus the situation before implementation. When taking total hospital costs and clinical effects into account, implementation of the SGC guideline increased total hospital costs per patient by 1.8 %, i.e. €355 (from €20,617 to €20,972) during the inpatient stay, while the number of patients in target glucose levels increased by 1.4 % (i.e. from 881 to 895 per 1000 patients). This translates to an incremental cost-effectiveness ratio of €25 per additional patient within the target glucose level. The model outcomes are most sensitive to changes in ICU length of stay.
Conclusion
The increase in the number of patients and time within target glucose levels is achieved with a small increase in total direct hospital costs
KW - METIS-310434
KW - IR-95811
U2 - 10.1007/s40258-015-0174-5
DO - 10.1007/s40258-015-0174-5
M3 - Article
SN - 1175-5652
VL - 13
SP - 399
EP - 407
JO - Applied health economics and health policy
JF - Applied health economics and health policy
IS - 4
ER -