A model-based cost-utility analysis of an automated notification system for deteriorating patients on general wards
Emily Holmes, Huw Lloyd Williams, Dyfrig Hughes, Elke Naujokat, Bernd Duller, Christian P. Subbe
Abstract:
Delayed response to clinical deterioration of hospital inpatients is common. Deployment of an electronic automated advisory vital signs monitoring and notification system to signal clinical deterioration is associated with significant improvements in clinical outcomes but there is no evidence on the cost-effectiveness compared with routine monitoring, in the National Health Service (NHS) in the United Kingdom (UK).
Introduction:
Deterioration of patients on general hospital wards often goes unnoticed for prolonged periods of time [1]. This delay can result in otherwise preventable cardiopulmonary arrest and admission to the intensive care unit (ICU) [2,3] even though, in most cases, measurable changes in vital signs [4] could identify patients at risk. Such delayed or absent response to deterioration has been labelled as “failure to rescue” [5].
Materials and Methods:
The study design was a model-based cost-effectiveness and cost-utility analysis using secondary data, including retrospective analysis of the Vital II Research Database (RDB).
The short-term cost-effectiveness analysis (cost per event avoided) was restricted to the inpatient episode, whilst the cost-utility analysis (cost per quality-adjusted life-year (QALY)) considered the longer-term consequences of serious adverse events to extrapolate the findings to a lifetime horizon.
Results:
The study population (n = 3787) had a median age of 71 years (Inter Quartile Range (IQR): 59–81), 52% were female, just over half were admitted to the pulmonology ward (56%), and the mean NEWS value on hospital admission was 3.15 (sd = 2.82) (S7 Table). Based on (unadjusted) observed data the frequency of adverse events per patient was lower with IGS (1.15 intervention versus 1.37 control).
Discussion:
Use of an automated notification system for deteriorating ward patients was cost-effective and associated with small costing saving in the analysis of data from a previous interventional study from the UK. Increased use of cableless sensors is associated with higher costs, however, the intervention remains cost-effective even when the rate is 100% (ICER: £3,107/QALY). Stratified cost-effectiveness analyses indicated that IGS, compared to spot-check monitors used in standard care, remains cost effective (dominant or below the ICER threshold for decision making) in all subgroups except NEWS on admission 6+.
Acknowledgments:
The authors would like to thank Laura Longshaw for her tireless work and expertise in bringing the approvals for this study together. Lynne Grundy acted as sponsor for the study. The authors would like to thank the clinical teams involved in the original study for their commitment to quality and safety of care. The authors would also like to express sincere gratitude to Goran Medic from Philips who has contributed to the successful completion of this article.
Conclusion:
Pragmatic use of automated monitoring in routine clinical practice for acute emergency admissions on general wards is an economically dominant strategy, where the joint distribution of costs and QALYs is associated with a positive net benefit. Adopting this technology is likely to result in both reduced costs and improved outcomes.
Citation: Holmes E, Lloyd Williams H, Hughes D, Naujokat E, Duller B, Subbe CP (2024) A model-based cost-utility analysis of an automated notification system for deteriorating patients on general wards. PLoS ONE 19(5): e0301643. https://doi.org/10.1371/journal.pone.0301643
Editor: Dominic Luke Thorrington, Haute Autorite de sante, FRANCE
Received: September 9, 2023; Accepted: March 19, 2024; Published: May 2, 2024
Copyright: © 2024 Holmes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: Yes - the study was funded by Philips Healthcare. Bangor University received funding from Betsi Cadwaladr University Health Board, Wales, UK to complete this research, via a Research Service subcontract of “Specific Research Plan for Economic Evaluation of Philips IntelliVue Guardian Solution (IGS)” incorporated into the Observational Field Test/Post Market Study Agreement between Philips Medizin Systeme Böblingen GmbH and Betsi Cadwaladr University Local Health Board.
Competing interests: Christian P Subbe has acted as principal investigator for clinical studies sponsored by Philips Healthcare, has served as an invited speaker for meetings hosted by Philips Healthcare and is a member of two advisory boards for Philips Healthcare. Elke Naujokat is an employee of Philips Medizin Systeme Böblingen GmbH. Bernd Duller is a consultant for Philips Medizin Systeme Böblingen GmbH.
Source: https://journals.plos.org/plosone/articleid=10.1371/journal.pone.0301643#references
